Surgical visualization systems

ABSTRACT

A surgical retractor includes a plurality of cameras integrated therein. One such retractor includes a tubular retractor and an insert supporting said plurality of cameras can be disposed within a tubular retractor.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/491,935, entitled “MEDICAL APPARATUS FOR USE WITH A SURGICAL TUBULARRETRACTOR”, filed Sep. 19, 2014, which claims the benefit of priority toU.S. Prov. App. No. 61/880,808, entitled “SURGICAL VISUALIZATIONSYSTEMS”, filed Sep. 20, 2013; to U.S. Prov. App. No. 61/920,451,entitled “SURGICAL VISUALIZATION SYSTEMS”, filed Dec. 23, 2013; to U.S.Prov. App. No. 61/921,051, entitled “SURGICAL VISUALIZATION SYSTEMS”,filed Dec. 26, 2013; to U.S. Prov. App. No. 61/921,389, entitled“SURGICAL VISUALIZATION SYSTEMS”, filed Dec. 27, 2013; to U.S. Prov.App. No. 61/922,068, entitled “SURGICAL VISUALIZATION SYSTEMS”, filedDec. 30, 2013; and to U.S. Prov. App. No. 61/923,188, entitled “SURGICALVISUALIZATION SYSTEMS”, filed Jan. 2, 2014. The entirety of eachapplication referenced in this paragraph is incorporated herein byreference.

BACKGROUND Field

Embodiments of the present disclosure relate to surgical devices andvisualization systems for use during surgery.

Description of Related Art

Some surgical operations involve the use of large incisions. These opensurgical procedures provide ready access for surgical instruments andthe hand or hands of the surgeon, allowing the user to visually observeand work in the surgical site, either directly or through an operatingmicroscope or with the aide of loupes. Open surgery is associated withsignificant drawbacks, however, as the relatively large incisions resultin pain, scarring, and the risk of infection as well as extendedrecovery time. To reduce these deleterious effects, techniques have beendeveloped to provide for minimally invasive surgery. Minimally invasivesurgical techniques, such as endoscopy, laparoscopy, arthroscopy,pharyngo-laryngoscopy, as well as small incision procedures utilizing anoperating microscope for visualization, utilize a significantly smallerincision than typical open surgical procedures. Specialized tools maythen be used to access the surgical site through the small incision.However, because of the small access opening, the surgeon's view andworkspace of the surgical site is limited. In some cases, visualizationdevices such as endoscopes, laparoscopes, and the like can be insertedpercutaneously through the incision to allow the user to view thesurgical site.

The visual information available to a user through laparoscopic ofendoscopic contain trade-offs in approach. Accordingly, there is a needfor improved visualization systems, for use in minimally invasivesurgery.

SUMMARY OF THE INVENTION

The systems, methods and devices of the disclosure each have severalinnovative aspects, no single one of which is solely responsible for thedesirable attributes disclosed herein.

In one aspect, a medical apparatus for use with a surgical tubularretractor configured to hold open an incision and thereby provide apathway for access of surgical tools to a surgical site, the surgicalretractor having a first end, a second end, and a longitudinal axisextending between the first and second ends, wherein the pathway extendsalong the longitudinal axis into the surgical site and the first end ismore proximal than the second end, the apparatus comprising: an imaginginsert configured to be received within the tubular retractor, theimaging insert comprising a proximal end and a distal end, wherein theimaging insert is configured to extend along the longitudinal axis ofthe tubular retractor between the first and second ends of the tubularretractor without substantially obstructing the pathway and maintainingthe pathway allowing the surgical tools to gain access to the surgicalsite through the proximal end of the imaging insert; and wherein theimaging insert comprises: a proximal head of the imaging insert at theproximal end, the proximal head configured to be disposed above thefirst end of the tubular retractor; and a plurality of cameras inwardlyfacing toward the pathway; and wherein the plurality of cameras aredisposed on an inner surface of the imaging insert. In some embodiments,the medical apparatus wherein the imaging insert further comprises anillumination assembly disposed on an inner surface of the imaginginsert. In some embodiments, the medical apparatus wherein the imaginginsert is substantially tubular and an outer surface of the imaginginsert is configured to contact an inner surface of the tubularretractor. In some embodiments, the medical apparatus wherein theimaging insert comprises one or more pieces configured to be extendingfrom the proximal head, and wherein an outer surface of the one or morea pieces is configured to contact an inner surface of the tubularretractor. In some embodiments, the medical apparatus wherein theimaging insert comprises one or more pieces configured to be disposedadjacent to one another, and wherein an outer surface of the one or morea pieces is configured to contact an inner surface of the tubularretractor. In some embodiments, the medical apparatus wherein theimaging insert comprises one or more annular pieces configured to bedisposed adjacent to one another to form a substantially tubular insert,and wherein an outer surface of the one or more annular pieces isconfigured to contact an inner surface of the tubular retractor. In someembodiments, the medical apparatus wherein the imaging insert comprisesa restraint configured to prohibit the imaging insert from passingcompletely through the pathway of the tubular retractor. In someembodiments, the medical apparatus wherein the proximal head of theimaging insert is wider than a distal portion of the imaging insert torestrain the imaging insert from passing completely through the pathwayof the tubular retractor. In some embodiments, the medical apparatuswherein the proximal end of the imaging insert abuts the first end ofthe tubular retractor and the distal end of the insert is configured tobe aligned with the second end of the tubular retractor. In someembodiments, the medical apparatus wherein the imaging insert isconfigured to slidably engage with the tubular retractor. In someembodiments, the medical apparatus wherein the imaging insert comprisesa ridge on an outer surface configured to correspond to a groove on aninner surface of the tubular retractor, wherein the groove is configuredto receive the ridge and to allow the insert to be slidably engaged withthe retractor. In some embodiments, the medical apparatus wherein theimaging insert comprises a groove on an outer surface configured tocorrespond to a ridge on an inner surface of the tubular retractor,wherein the groove is configured to receive the ridge and to allow theinsert to be slidably engaged with the retractor. In some embodiments,the medical apparatus wherein at least one of the plurality of camerasare on a flexible cable is configured to be moved between the proximaland distal end of the imaging insert. In some embodiments, the medicalapparatus wherein the flexible cable is configured to be fed through aslot on the proximal head of the imaging insert, wherein the at leastone of the plurality of cameras on the flexible cable is moved closer orfurther from the distal end as the flexible cable is raised and loweredwithin the imaging insert. In some embodiments, the medical apparatusfurther comprising a plurality of connectors on the proximal head of theimaging insert, wherein the plurality of connectors comprise an opticalfiber input port, a fluid port, or an air port. In some embodiments, themedical apparatus wherein the illumination assembly comprises at leastone illumination source, the at least one illumination source comprisinglight guides or fibers. In some embodiments, the medical apparatuswherein the illumination assembly comprises at least one illuminationsource, the at least one illumination source configured to belongitudinally movable along a length of the imaging insert. In someembodiments, the medical apparatus wherein the plurality of cameras areconfigured to be longitudinally movable along a length of the imaginginsert.

In another aspect, a medical apparatus comprising: a camera platform,the camera platform comprising a camera module; a flexible joint; amovement assembly; and a retractor connector surface, the retractorconnector surface configured to be mounted to a surface of a retractor;wherein the flexible joint is configured to permit movement of thecamera platform relative to the retractor connector surface. In someembodiments, the medical apparatus wherein the movement assemblycomprises at least one set of push-pull cables. In some embodiments, themedical apparatus wherein the movement assembly comprises anelectro-mechanical actuator configured to actuate the at least one setof push-pull cables. In some embodiments, the medical apparatus whereinthe movement assembly comprises an actuator configured to move thecamera platform, wherein the actuator is pneumatically or hydraulicallydriven.

In certain aspects, a movable mechanical device for positioning a cameraon a surgical device is disclosed. The device can include a cameraplatform configured to attach to the camera, a surgical device connectorsurface configured to attach to the surgical device, and an electromechanical actuator configured to control the position of the camera.The electro mechanical actuator can comprise a Micro-Electro-MechanicalSystem (MEMS) actuator. In some embodiments, the surgical device caninclude a surgical tool. In other embodiments, the surgical device caninclude a retractor configured to hold open a surgical incision and toprovide access to a surgical site.

In certain aspects, an imaging module for disposing on a surgical deviceis disclosed. The imaging module can be configured to provide images ofa surgical site within a field-of-view of the imaging module. Theimaging module can include at least one optical sensor having at leastone active detection area on a front face of the at least one opticalsensor. The imaging module can also include first and second channels.The first channel can include first imaging optics configured to focuslight from the surgical site onto the at least one active detection areato form left-eye view images of the surgical site on the at least oneactive detection area. The first imaging optics can comprise one or morelenses. The second channel can include second imaging optics configuredto focus light from the surgical site onto the at least one activedetection area to form right-eye view images of the surgical site on theat least one active detection area. The second imaging optics caninclude one or more lenses.

The imaging module can also include redirection optics between the firstand second imaging optics and the at least one active detection area.The redirection optics can be configured to redirect light from thefirst and second imaging optics to the at least active detection areasuch that the at least one optical sensor can be oriented so as toreduce obstruction to the surgical site by the at least one opticalsensor. In addition, the imaging module can include a mask associatedwith the at least one optical sensor. The mask can be configured topartition the at least one active detection area of the at least oneoptical sensor to define left-eye and right-eye views of the left-eyeand right-eye view images.

In various embodiments, the mask can be an electronic mask implementedvia software. The mask can be configured to be movable along an axis ofthe at least one optical sensor. The mask can include two portions. Adistance between the two portions can be configured to be adjustable.For example, the distance between the two portions can be configured tobe adjustable to control a convergence angle of the imaging module. Insome embodiments, the mask can comprise an opening and a size of theopening can be adjustable. The mask can be configured to be controllablevia a user interface.

In some embodiments, the at least one optical sensor can comprise asingle sensor comprising a single chip. In other embodiments, the atleast one optical sensor can comprise first and second sensors. Inaddition, in some embodiments, the redirection optics can comprise firstand second prisms.

The imaging module of certain embodiments can be disposed on a surgicaltool. In other embodiments, the imaging module can be disposed on aretractor configured to hold open a surgical incision and to provideaccess to the surgical site.

In certain aspects, a stereo optical assembly for disposing on asurgical device is disclosed. The assembly can be configured to providestereo imaging of a surgical site within a field-of-view of theassembly. The stereo optical assembly can include an imaging module. Theimaging module can include an optical sensor assembly comprising one ormore optical sensors. The imaging module can also include first andsecond channels. The first channel can comprise first imaging opticsconfigured to focus light from the surgical site onto the optical sensorassembly to form left-eye view images of the surgical site on theoptical sensor assembly. The first imaging optics can include one ormore lenses. The second channel can comprise second imaging opticsconfigured to focus light from the surgical site onto the optical sensorassembly to form right-eye view images of the surgical site on theoptical sensor assembly. The second imaging optics can include one ormore lenses.

The imaging module can also include first and second redirection optics.The first redirection optics can be between the first and second imagingoptics and the optical sensor assembly. The first redirection optics canbe configured to redirect light from the first and second imaging opticsto the optical sensor assembly such that the optical sensor assembly canbe oriented so as to reduce obstruction to the surgical site by theoptical sensor assembly. The second redirection optics can be configuredto redirect light from the surgical site to the first and second imagingoptics. The second redirection optics can be configured to control aconvergence angle of the imaging module. For example, the secondredirection optics is configured to increase the convergence angle ofthe imaging module.

In some embodiments of the stereo optical assembly, the first and secondchannels can comprise first and second ends respectively. The first andsecond ends can be configured to receive light from the secondredirection optics. The second redirection optics can comprise first andsecond optical apertures configured to receive light from the surgicalsite. A center-to-center distance between the first and second opticalapertures can be greater than a center-to-center distance between thefirst and second ends. In some embodiments, the second redirectionoptics can include first and second prisms.

In various embodiments, the imaging module is a first imaging module,and the stereo optical assembly further comprises a second imagingmodule. The second imaging module can include a second optical sensorassembly comprising one or more optical sensors. The second imagingmodule can also include a third channel and a fourth channel. The thirdchannel can comprise third imaging optics configured to focus light fromthe surgical site onto the second optical sensor assembly to form secondleft-eye view images of the surgical site on the second optical sensorassembly. The third imaging optics can include one or more lenses. Thefourth channel can comprise fourth imaging optics configured to focuslight from the surgical site onto the second optical sensor assembly toform second right-eye view images of the surgical site on the secondoptical sensor assembly. The fourth imaging optics can include one ormore lenses.

The second imaging module can also include third redirection opticsbetween the third and fourth imaging optics and the second opticalsensor assembly. The second redirection optics can be configured toredirect light from the third and fourth imaging optics to the secondoptical sensor assembly.

In some such embodiments, the first imaging module has a firstconvergence angle, the second imaging module has a second convergenceangle, and the first convergence angle is substantially equal to thesecond convergence angle. The first imaging module is located at aproximal location, the second imaging module is located at a distallocation, and the distal location is configured to be disposed closer tothe surgical site than the proximal location.

The first imaging module can comprise a movable electronic maskassociated with the optical sensor assembly or the second imaging modulecan comprise a movable electronic mask associated with the secondoptical sensor assembly. In some embodiments, the optical sensorassembly comprises a single sensor comprising a single chip. In otherembodiments, the optical sensor assembly comprises first and secondsensors. The first redirection optics can include first and secondprisms.

The stereo optical assembly of certain embodiments can be disposed on asurgical tool. In other embodiments, the stereo optical assembly can bedisposed on a retractor configured to hold open a surgical incision andto provide access to the surgical site.

In certain aspects, a stereo optical assembly for disposing on asurgical device is disclosed. The assembly can be configured to providestereo imaging of a surgical site within a field-of-view of theassembly. The assembly can include a proximal imaging module at aproximal location. The proximal imaging module can be configured toprovide a first left-eye view and a first right-eye view of the surgicalsite. The assembly can also include a distal imaging module at a distallocation. The distal imaging module can be configured to provide asecond left-eye view and a second right-eye view of the surgical site.The distal location can be configured to be disposed closer to thesurgical site than the proximal location. In addition, an effectiveseparation distance between the first left-eye and right-eye views canbe larger than an effective separation distance between the secondleft-eye and right-eye views.

In various embodiments, the proximal imaging module has a firstconvergence angle, the distal imaging module has a second convergenceangle, and the first convergence angle is substantially equal to thesecond convergence angle. In some embodiments, at least one of theeffective separation distance between the first left-eye and right-eyeviews and the effective separation distance between the second left-eyeand right-eye views can be defined by a plurality of prisms. In someembodiments, the effective separation distance between the firstleft-eye and right-eye views can be defined by a movable electronic maskassociated with an optical sensor of the proximal imaging module or theeffective separation distance between the second left-eye and right-eyeviews can be defined by a movable electronic mask associated with anoptical sensor of the distal imaging module.

In certain aspects, an imaging module for disposing on a surgical deviceis disclosed. The imaging module can be configured to provide images ofa surgical site within a field-of-view of the imaging module. Theimaging module can include at least one optical sensor having at leastone active detection area on a front face of the at least one opticalsensor. The imaging module can also include first and second channels.The first channel can include first imaging optics configured to focuslight from the surgical site onto the at least one active detection areato form left-eye view images of the surgical site on the at least oneactive detection area. The first imaging optics can comprise one or morelenses. The second channel can include second imaging optics configuredto focus light from the surgical site onto the at least one activedetection area to form right-eye view images of the surgical site on theat least one active detection area. The second imaging optics caninclude one or more lenses.

The imaging module can also include redirection optics between the firstand second imaging optics and the at least one active detection area.The redirection optics can be configured to redirect light from thefirst and second imaging optics to the at least active detection areasuch that the at least one optical sensor can be oriented so as toreduce obstruction to the surgical site by the at least one opticalsensor.

In some embodiments, the at least one optical sensor can comprise asingle sensor comprising a single chip. In other embodiments, the atleast one optical sensor can comprise first and second sensors. Inaddition, in some embodiments, the redirection optics can comprise firstand second prisms.

The imaging module of certain embodiments can be disposed on a surgicaltool. In other embodiments, the imaging module can be disposed on aretractor configured to hold open a surgical incision and to provideaccess to the surgical site.

In various aspects, a stereo camera system is provided. The stereocamera system can include a pair of image sensors comprising a leftimage sensor and a right image sensor. Each of the pair of image sensorscan have an active detection area on a front face of the image sensor.The left image sensor can be offset along a first direction from theright image sensor. In addition, the front face of the left image sensorcan be oriented such that a plane of the front face of the left imagesensor is parallel to a plane of the front face of the right imagesensor. The front face of the left image sensor can face the front faceof the right image sensor. Each of the planes of the front faces can beoriented perpendicular to the first direction.

In various embodiments, the stereo camera system can include a pair oflens trains comprising a left lens train having a plurality of lenselements along a left optical path and a right lens train having aplurality of lens elements along a right optical path. The left opticalpath can be offset along the first direction from the right opticalpath. The stereo camera system can also include a pair of opticalredirection elements comprising a left optical redirection elementpositioned along the left optical path and configured to redirect theleft optical path to the front face of the left image sensor and a rightoptical redirection element positioned along the right optical path andconfigured to redirect the right optical path to the front face of theright image sensor.

In some embodiments of the stereo camera system, the left opticalredirection element comprises a left prism and the right redirectionelement comprises a right prism. In some such embodiments, the leftprism can be offset from the right prism along the first direction. Theleft prism can comprise a primary reflective face that is orthogonal toa primary reflective face of the right prism. In some embodiments, theleft optical redirection element comprises a left mirror and the rightredirection element comprises a right mirror.

In some embodiments, the left optical redirection element can beconfigured to redirect the left optical path 90 degrees and the rightoptical redirection element can be configured to redirect the rightoptical path 90 degrees. The redirected left optical path and theredirected right optical path can be anti-parallel to one another. Insome embodiments, the left optical path and the right optical path canbe parallel.

In various embodiments, the left image sensor can be a two-dimensionaldetector array and the right image sensor can also be a two-dimensionaldetector array. For example, the left image sensor can be a CCD detectorarray and the right image sensor can also be a CCD detector array.

In various aspects, a stereo camera system is provided. The stereocamera system can comprise a pair of image sensors comprising a leftimage sensor and a right image sensor. The stereo camera system can alsocomprise a pair of lens trains comprising a left lens train having aplurality of lens elements along a left optical path and a right lenstrain having a plurality of lens elements along a right optical path.The left optical path can be offset laterally from the right opticalpath. The stereo camera system can also comprise a pair of opticalredirection elements comprising a left optical redirection elementpositioned along the left optical path and configured to redirect theleft optical path to the front face of the left image sensor and a rightoptical redirection element positioned along the right optical path andconfigured to redirect the right optical path to the front face of theright image sensor.

Furthermore, certain embodiments also include a surgical visualizationsystem comprising a plurality of camera systems. At least one of theplurality of camera systems can include a stereo camera system inaccordance with certain embodiments as described herein. Variousembodiments also include a retractor including a stereo camera system asdescribed herein disposed thereon. In addition, some embodiments includea surgical tool including a stereo camera system as described hereindisposed thereon.

In various aspects, a surgical visualization system display isdisclosed. The surgical visualization system display can include atleast one camera configured to acquire video images of a surgical tool.The at least one camera can be configured to be disposed on a surgicaldevice. The surgical visualization system can also include an imageprocessing system in communication with the at least one camera. Theimage processing system can comprise at least one physical processor. Incertain embodiments, the image processing system can be configured toreceive tracking information associated with the location of thesurgical tool, and to adjust a focal length and/or orientation of the atleast one of camera, based at least in part on the received trackinginformation.

In various embodiments, the image processing system can be configured toadjust a focal length and/or orientation of the at least one camera soas to maintain focus of the surgical tool with movement of the surgicaltool. The at least one camera can comprise a plurality of cameras. Thesurgical device can comprise a retractor.

In some embodiments, the image processing system can be configured toadjust the focal length of the at least one camera, based at least inpart on the received tracking information. In some embodiments, theimage processing system can be configured to adjust the orientation ofthe at least one camera, based at least in part on the received trackinginformation.

The surgical visualization system display can further include a footpedal, where actuation of the foot pedal can be configured to send asignal causing the image processing system to receive trackinginformation associated with the location of the surgical tool, and toadjust a focal length and/or orientation of the at least one camera,based at least in part on the received tracking information.

In certain aspects, a surgical visualization system display isdisclosed. The surgical visualization system display can include atleast one camera disposed on a surgical tool and configured to acquirevideo images of a surgical site. The surgical visualization systemdisplay can also include an image processing system in communicationwith the at least one camera. The image processing system can compriseat least one physical processor. The image processing system can beconfigured to receive tracking information associated with the locationof the surgical tool, and to adjust a focal length and/or orientation ofthe at least one camera, based at least in part on the received trackinginformation.

In some embodiments, the image processing system can be configured toadjust the focal length of the at least one camera, based at least inpart on the received tracking information. In some embodiments, theimage processing system can be configured to adjust the orientation ofthe at least one camera, based at least in part on the received trackinginformation.

In another aspect, a medical apparatus comprising a surgicalvisualization system console; and a drive system disposed within theconsole and in communication with at least one surgical tool, whereinthe drive system comprises at least one drive board configured to drivethe at least one surgical tool. In some embodiments, the medicalapparatus wherein the drive system comprises an ultrasonic driver board.In some embodiments, the medical apparatus wherein the drive systemcomprises a radiofrequency (RF) driver board. In some embodiments, themedical apparatus wherein the RF driver board is configured to supportat least two modulation formats associated with at least two surgicaltools, respectively. In some embodiments, the medical apparatus whereinthe at least one surgical tool comprises an ultrasonic tissue aspirator,bipolar coagulation and cutting tool, bipolar forceps, or a combinationthereof. In some embodiments, the medical apparatus comprising a footpedal in communication with the drive system. In some embodiments, themedical apparatus wherein the foot pedal is configured to send a signalto the drive system indicative of a power level associated with the oneor more surgical tools. In some embodiments, the medical apparatuswherein the power level is proportional to a degree to which the footpedal is configured to be depressed.

In another aspect, a method of driving surgical tools, the methodcomprising receiving a signal from a foot pedal to drive a firstsurgical tool, wherein the signal includes information as to a degree towhich the foot pedal is depressed; and driving power to the firstsurgical tool in proportion to the degree to which the foot pedal isdepressed. In some embodiments, the method further comprising, drivingpower to a second surgical tool, wherein the second surgical tool has amodulation format different than that of the first surgical tool.

In certain aspects, a surgical visualization system display isdisclosed. The surgical visualization system display can include aplurality of cameras, at least one disposed on a retractor. A firstcamera of the plurality can be configured to image fluorescence in asurgical site. A second camera of the plurality can be configured toproduce a non-fluorescence image of said surgical site. The first andsecond cameras can have different spectral responses. For example, insome embodiments, one of the first and second cameras is sensitive toinfrared and the other is not.

In another aspect, a surgical visualization system configured to receiveimages from one or more cameras, the surgical visualization systemcomprising a display, electronics configured to receive and processimage signals from the one or more cameras, an input connectorconfigured to fluidly connect with a source of pneumatic pressure, andone or more pneumatic outputs configured to fluidly connect to the inputconnector. In some embodiments, surgical visualization system furthercomprising a hydraulic pressure circuit having one or more valves,wherein at least one of the one or more pneumatic outputs is configuredto operate one or more of the valves of the hydraulic pressure circuit.In some embodiments, surgical visualization system wherein the hydraulicpressure circuit is fluidly connected to one or more surgical tools andis configured to operate the one or more surgical tools using hydraulicpressure. In some embodiments, surgical visualization system wherein atleast one of the one or more valves is an elastomeric proportionalvalve. In some embodiments, surgical visualization system wherein atleast one of the one or more pneumatic outputs is a solenoid. In someembodiments, surgical visualization system wherein at least one of theone or more pneumatic outputs is a piston. In some embodiments, surgicalvisualization system wherein at least one of the pneumatic outputs is apneumatic actuator. In some embodiments, surgical visualization systemfurther comprising one or more valves positioned on fluid lines betweenthe source of pneumatic pressure and the one or more pneumatic outputs.In some embodiments, surgical visualization system further comprising ahydraulic cassette assembly. In some embodiments, surgical visualizationsystem wherein at least one of the one or more pneumatic outputs isconfigured to operate a cassette lifter configured to raise and/or lowerthe hydraulic cassette assembly. In some embodiments, surgicalvisualization system wherein one or more of the pneumatic outputs areconfigured to operate as a tube ejector for a peristaltic pump.

In another aspect, a surgical tool comprising a proximal handle portion,a distal handle portion connected to the proximal handle portion androtatable with respect to the proximal handle portion about an axis ofrotation, a base portion connected to the distal handle portion andfixed thereto in a direction parallel to the axis of rotation, a topportion connected to the distal handle portion and movable with respectto the distal handle portion in the direction parallel to the axis ofrotation, the top portion having a cutting edge on a distal end of thetop portion configured to operate with a cutting portion on the baseportion to cut bone or tissue, a proximal actuation chamber within theproximal handle portion, a piston connected to the top portion and fixedthereto in the direction parallel to the axis of rotation; and anactuation element positioned at least partially within the proximalactuations chamber and configured to exert an axial force on the pistonin the direction parallel to the axis of rotation. In some embodiments,the surgical tool further comprising a distal actuation chamber withinthe distal handle portion. In some embodiments, the surgical toolfurther comprising a biasing element positioned within one or more ofthe proximal handle portion and the distal handle portion and configuredto bias the piston in a direction parallel to the axis of rotation andaway from a distal end of the base portion. In some embodiments, thesurgical tool wherein the actuation element is a bag or balloonconfigured to be inflated by a source of physiological saline. In someembodiments, the surgical tool further comprising a return valveconfigured to introduce physiological saline to the tool to compress theactuation element.

In another aspect, a surgical tool comprising; a hydraulic impellerassembly comprising a turbine housing defining a blade cavity, a flowdirector positioned at least partially within the turbine housing, animpeller having a plurality of impeller blades, the impeller positionedat least partially within the blade cavity, an output shaft rotatablyconnected to the impeller and configured to transfer a torque from theimpeller to a drill, and one or more ports in a wall of the blade cavityproviding fluid communication between an interior of the blade cavityand an exterior of the blade cavity; a hydraulic fluid input port; apneumatic fluid input port; and a controller configured to control aproportion of pneumatic and hydraulic fluids input into the bladecavity. In some embodiments, the surgical tool further comprising afluid output port line configured to facilitate fluid communicationbetween at least one of the one or more ports and a hydraulic pressuresource. In some embodiments, the surgical tool further comprising avacuum source configured to extract fluid from the blade cavity throughthe one or more ports in the wall of the blade cavity. In someembodiments, the surgical tool wherein the vacuum source is an externalpump. In some embodiments, the surgical tool wherein the vacuum sourceis a bypass channel in the turbine housing in fluid communication withthe blade cavity via the one or more ports, wherein a low pressure fluidis passed through the bypass channel to draw fluid out from the bladecavity via the Venturi effect. In some embodiments, the surgical toolwherein the low pressure fluid is a gas. In some embodiments, thesurgical tool wherein at least a portion of the fluid extracted from theblade cavity is physiological saline. In some embodiments, the surgicaltool wherein the hydraulic impeller assembly is configured to receiveboth pressurized hydraulic fluid and pressurized pneumatic fluid torotate the impeller. In some embodiments, the surgical tool wherein thecontroller is configured to increase the proportion of hydraulic fluidinput to the blade cavity when higher torque is desired and to increasethe proportion of pneumatic fluid input to the blade cavity when ahigher rotational speed is desired.

In another aspect, a medical apparatus comprising a surgical device, atleast one camera disposed on the surgical device, and a hydraulic systemconfigured to deliver fluid to the at least one camera to removeobstructions therefrom, wherein said hydraulic system comprises apulsing valve connected to a high pressure source of said fluidconfigured to provide pulses of fluid. In some embodiments, the medicalapparatus wherein said pulsing valve comprises a pop off valveconfigured to open when a pressure threshold is reached to provideincreased pressure beyond the threshold value resulting in a pulse ofliquid from the pulsing valve. In some embodiments, the medicalapparatus wherein said at least one camera comprises a plurality ofcameras and said pulsing valve is disposed in said hydraulic system suchthat the fluid is delivered to each of the plurality of cameras at thesame time. In some embodiments, the medical apparatus wherein saidpulsing valve is disposed in a line that splits into different fluidoutlets to clean different cameras, said pulsing valve disposed upstreamof said split. In some embodiments, the medical apparatus wherein saidhydraulic system is further configured to deliver pressurized air to theat least one camera after said fluid is delivered. In some embodiments,the medical apparatus wherein said surgical device comprises aretractor.

In another aspect, a medical apparatus comprising a surgical device, atleast one camera disposed on the surgical device, and a hydraulic systemconfigured to deliver air to the at least one camera, wherein saidhydraulic system comprises a pulsing valve connected to a high pressuresource of air to provide pulses of air. In some embodiments, the medicalapparatus wherein said pulsing valve comprises a pop off valveconfigured to open when a pressure threshold is reached to provideincreased pressure beyond the threshold value resulting in a pulse ofair from the pulsing valve.

In another aspect, a medical apparatus comprising a surgical device, atleast one camera disposed on the surgical device, said at least onecamera having camera optics, and a hydraulic system configured todeliver fluid and air to the camera optics of said at least one camerato remove obstructions therefrom, wherein said hydraulic systemcomprises a three way valve connected to a supply of said fluid and asupply of high pressure air, said three way valve configured toselectively shut off said supply of fluid and to provide insteadpressurized air thereby reducing inadvertent leakage of fluid onto thecamera optics. In some embodiments, the medical apparatus wherein saidhydraulic system is configured to deliver fluid pulses and air pulses tosaid at least one camera. In some embodiments, the medical apparatusfurther comprising a pop off valve, wherein said three way valve isdisposed downstream of said pop off valve. In some embodiments, themedical apparatus wherein said surgical device comprises a retractor.

In another aspect, a medical apparatus comprising a surgical device, atleast one camera disposed on the surgical device, said at least onecamera having camera optics, and a hydraulic system comprising a valveconnected to a high pressure source of fluid and configured to deliverfluid to the camera optics of said at least one camera to removeobstructions therefrom, wherein said hydraulic system is configured toopen said valve periodically based on a pre-programmed schedule or aschedule selected by a user.

In another aspect, a medical apparatus comprising a surgical device, atleast one camera disposed on the surgical device, said at least onecamera having camera optics, and a hydraulic system comprising a valveconnected to a high pressure source of fluid and configured to deliverfluid to the camera optics of said at least one camera to removeobstructions therefrom, wherein said hydraulic system is configureddeliver fluid when an obstruction reducing the amount of light enteringthe camera is detected. In some embodiments, the medical apparatuswherein said at least one camera produces an image signal and saidapparatus is configured to monitor said image signal to determine whenvisibility is compromised and thereby trigger delivery of said fluid toclean the camera optics. In some embodiments, the medical apparatuswherein camera intensity is monitored. In some embodiments, the medicalapparatus wherein attenuation of red wavelength compared to greenwavelength is monitored to determine whether blood is on the camerareducing the amount of light entering the camera.

In another aspect, a suction system for a surgical system, the suctionsystem comprising: a suction cassette including: a cassette housing; anda plurality of ports facilitating fluid communication between aninterior and an exterior of the cassette housing; a first suction linein fluid communication with the suction cassette and configured to bepositioned in fluid communication with a surgical site; a second suctionline in fluid communication with the suction cassette and configured tobe positioned in fluid communication with the surgical site; and astorage tank in fluid communication with the suction cassette. In someembodiments, the suction system further comprising a connector in fluidcommunication with the suction cassette and with a vacuum source. Insome embodiments, the suction system wherein the vacuum source maintainsa pressure below ambient pressure within the storage tank. In someembodiments, the suction system wherein the first suction line isconfigured to operate as a high flow suction line to suction heavybleeding. In some embodiments, the suction system wherein the secondsuction line is configured to operate as a low flow suction line toidentify and coagulate low flow bleeding. In some embodiments, thesuction system further comprising an intermediate storage tankpositioned at least partially within the cassette housing and in fluidcommunication with one or more of the first suction line and the secondsuction line. In some embodiments, the suction system further comprisinga pump positioned on a fluid line between the intermediate storage tankand the storage tank to pull material from the intermediate storage tankto the storage tank. In some embodiments, the suction system wherein thepump is a peristaltic pump.

A separate apparatus can include a translation system having an upperconnecting member and a lower connecting member, the translation systemdesigned to have a component attached to the translation system, whereinthe component is configured to translate relative to the upperconnecting member along at least a first axis and a second axis, apitch-yaw adjustment system designed to attach to the component, thepitch-yaw adjustment system designed to rotate the component about ajoint around an axis parallel to the first axis and rotate the componentabout the joint around an axis parallel to the second axis, a firstcontrol member designed to attach to the translation system via one ormore control member joints, wherein the first control member isphysically coupled to both the translation system and the pitch-yawadjustment system so as to provide control thereto.

In some embodiments, the component can be attached to the lowerconnecting member via an arm. In some embodiments, the first controlmember can be physically coupled to the translation system such that thecomponent can be translated along the first axis or second axis bytranslating the first control member in the direction parallel to thefirst axis or second axis respectively. In some embodiments, the firstcontrol member can be designed to connect to a component of theapparatus via a joint having three rotational degrees of freedom. Insome embodiments, the first control member can be designed to connect tothe translation system via the lower connecting member. In someembodiments, the translation system can also include a guide assemblydesigned to attach the upper connecting member to the lower connectingmember, wherein the guide assembly can be positioned between the upperconnecting member and the lower connecting member. In some embodiments,the first control member can be physically coupled to the pitch-yawadjustment system such that the component can be rotated about the jointaround the first axis or second axis by rotating the first controlmember about the control member joint around an axis parallel to thefirst axis or second axis respectively. In some embodiments, thepitch-yaw adjustment system can be designed such that rotation of thefirst control member about the control member joint can result in abouta one-to-one rotation of the component about the joint. In someembodiments, the pitch-yaw adjustment system can be designed such thatrotation of the first control member about the control member joint canresult in greater than a one-to-one rotation of the component about thejoint. In some embodiments, the pitch-yaw adjustment system can bedesigned such that rotation of the first control member about thecontrol member joint can result in less than a one-to-one rotation ofthe component about the joint.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-C show an embodiment of a surgical retractor device having anintegrated imaging assembly.

FIG. 2A is a schematic illustration of a tubular retractor and animaging insert including an illumination assembly and a camera module.

FIG. 2B is a schematic cross-section of a retractor having an imaginginsert received therein.

FIGS. 3A-E are schematic illustrations of a tubular retractor assemblywith imaging insert received therein.

FIG. 4A shows a cross-section of a tubular insert comprising a hollowright circular cylinder having guides on the outer surface of the insertthat contact the inner surface of the retractor tube.

FIG. 4B shows a tubular insert in the shape of a hollow right circularcylinder as and an upper support configured to rest above a retractor.

FIG. 4B-4E shows tubular inserts partitioned into separate segments asseen in the cross-section orthogonal to the length of the insert.

FIG. 5A illustrates example embodiments of stereo optical assemblies forproximal and distal cameras on the retractor.

FIG. 5B illustrates an example two-dimensional image sensor with a pairof prisms and a single chip employed for stereo camera.

FIG. 5C illustrates an example two-dimensional image sensor with a pairof prisms and two chips employed for stereo camera.

FIGS. 6A-6D are schematic illustrations of a camera module with flexcable, according to various embodiments.

FIG. 7A illustrates a cross-sectional view of an embodiment of aflexible mount for a camera on a retractor.

FIG. 7B illustrates an embodiment of the retractor blade, camera, andmovement cable system for moving a camera with respect to a retractorblade.

FIG. 8A shows a schematic illustration of a surgical visualizationsystem including a foot pedal.

FIG. 8B illustrates an embodiment of multiple foot pedals 10801 within aframe.

FIGS. 9A-9C are schematic illustrations of an embodiment of apneumatically actuated tool.

FIG. 9D is a schematic illustration of another embodiment of ahydraulically actuated surgical device.

FIG. 9E is a schematic illustration of an embodiment of a cutting tip ofthe surgical device embodiment of FIG. 9D.

FIG. 9F is a schematic illustration of another embodiment of a cuttingtip of the surgical device embodiment of FIG. 9D.

FIG. 9G is a schematic illustration of another embodiment of a cuttingtip of the surgical device embodiment of FIG. 9D.

FIG. 10A shows a perspective cross-section of a hydraulic turbine.

FIG. 10B shows a cross-section of a portion of the hydraulic turbine ofFIG. 10A.

FIG. 10C shows a cross-section of a portion of the hydraulic turbine ofFIG. 10A and a diverted fluid flow path.

FIG. 11 shows one embodiment of an impeller.

FIG. 12 is a schematic illustration of a medical suction system.

FIG. 13 is a schematic illustration of a pneumatic actuator circuit.

FIG. 14A is a perspective view of an embodiment of an apparatus having atranslation system and a pitch-yaw adjustment system.

FIG. 14B is a partial section view of the apparatus of FIG. 14A.

FIG. 15 is a partial section view of an embodiment of an apparatushaving a translation system, a pitch-yaw adjustment system, and az-distance adjustment system.

FIG. 16A is a front view of an embodiment of a pitch-yaw adjustmentsystem having greater than a one-to-one adjustment ratio.

FIG. 16B is a front view of an embodiment of a pitch-yaw adjustmentsystem having a one-to-one adjustment ratio.

FIG. 16C is a front view of an embodiment of a pitch-yaw adjustmentsystem having less than a one-to-one adjustment ratio.

FIG. 16D is a front view of an embodiment of a pitch-yaw adjustmentsystem having a variable adjustment ratio.

FIG. 17 is a perspective view of an embodiment of an arm for acomponent.

FIG. 18 is a perspective view of an embodiment of an arm for acomponent.

FIG. 19A is a perspective view of an embodiment of a z-distanceadjustment system.

FIG. 19B is a perspective view of an embodiment of a z-distanceadjustment system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The following description is directed to certain embodiments for thepurposes of describing the innovative aspects of this disclosure.However, a person having ordinary skill in the art will readilyrecognize that the teachings herein can be applied in a multitude ofdifferent ways. Thus, the teachings are not intended to be limited tothe embodiments depicted solely in the figures. and described herein,but instead have wide applicability as will be readily apparent to onehaving ordinary skill in the art.

Cameras on Retractors

FIGS. 1A-C show one embodiment a surgical retractor device that includesan integrated imaging assembly. In some embodiments, the imagingassembly includes a plurality of integrated cameras. The retractor 100includes three blades 101, however, more or less may be includeddepending on the design. Each of the blades may be attached to anarticulable arm 103 that allows for the position of the blades to beadjusted during the operation. For example, following a small incision,the three blades 101 can be arranged in a closed position where each arepositioned close to one another. In this closed configuration, the threeblades can be introduced through the incision, and then expanded toprovide for an operating pathway or working space. In other embodiments4, 5, 6, 7, 8 or more blades, fingers, retractor members, or otherbarriers may be employed (or fewer members such as two blades, etc., oreven a single member such as a single lumen of a tubular retractor maybe used). In various embodiments, the surgical area may be at least 400mm², for example, have an opening with an areas between 400 and 2100mm². The working space may be an area centrally located betweenretractor blades (or within the lumen of a tubular retractor) thatallows for surgical tools or other instruments to pass through. Asshown, the retractor does not obstruct the center of the retractor(e.g., array of retractor blades, finger, members, etc., or lumen of atubular retractor) and the open region formed by the retractor andpermits unobstructed access to the center of the surgical site for readyaccess by the surgeon. Each of the blades 101 includes one or moreintegrated cameras, or cameras with combined stereo paths to one sensoror camera module 105. In various embodiments the number of cameramodules and configurations can vary. In the illustrated embodiment, eachcamera module 105 includes a camera 107 and one or more, or twoillumination sources 109 disposed on opposite sides of the camera 107.In various embodiments, the number of illumination sources per cameramodule may vary. In some embodiments, the illumination sources may notbe disposed directly adjacent any particular camera. In someembodiments, the illumination sources can be omitted, and the cameramodule can rely on ambient supplementary or overhead light or lightdirected from a light source located elsewhere. In some embodiments, theorientation of an integrated camera 107 may be substantially fixed withrespect to the retractor blade 101 or other surgical tool. In someembodiments, the camera 107 and/or the camera module 105 may beadjustable with respect to the retractor blade 101.

In the illustrated embodiment, the retractor blades 101 aresubstantially rigid. In various embodiments, the retractor blades may bemalleable, and may have a wide range of different structural featuressuch as width, tension, etc. For example, stronger, larger retractorblades may be desired for spinal and trans-oral surgery, while weaker,smaller retractor blades may be desired for neurosurgery. In someembodiments, the retractor can be configured such that different bladescan be arranged as desired.

Each of the camera modules 105 are in electrical communication with anaggregator 104. The aggregator 104 is configured to receive input fromeach of the camera modules 105, and to connect to external componentsvia electrical cable 108. For example, the hub or aggregator 104 mayreceive image data from each of the camera modules 105 and may transmitthe image data to an image processing module (not shown). In theillustrated embodiment, the wiring connecting the camera modules 105with the aggregator 104 is imbedded within the retractor blades 101 andarticulating arms 103 and is not visible. In some embodiments, asdescribed in more detail below, cables connecting the camera modules 105with the aggregator 104 may be adhered (either permanently ornon-permanently, e.g., releasably) to the exterior surface of theretractor 100. In the illustrated embodiment, the hub or aggregator 104is affixed to an upper surface of the retractor 100. The aggregator maybe positioned at any locations relative to the retractor 100, or may bedisconnected from the retractor 100 altogether. The aggregator maycontain camera interface electronics, tracker interface electronics andSERDES to produce a high speed serial cable supporting all cameras inuse. In various embodiments, the retractor camera output is coupled to aconsole which causes video from the retractor camera to be presented ondisplay.

Although the illustrated embodiment shows integrated camera modules 105,in various embodiments the camera modules 105 may be removably attachedto the retractor blades 101. In some embodiments, the camera modules 105can be disposed within pre-positioned receptacles on the retractorblades 101 or other surgical device. In some embodiments, the cameramodules 105 can be disposed at a plurality or range of locations desiredby the user on the retractor blades 101. In various embodiments, theorientation and position of the sensors can be adjusted by the user,e.g., physician, nurse, technician, or other clinician. In someembodiments, for example, the camera may be disposed on a track suchthat the camera can slide up and down the retractor, e.g., retractorblade. The height of the camera or camera within or above the surgicalsite may thereby be adjusted as desired. Other arrangements forlaterally adjusting the position of the camera may be used.Additionally, in various embodiments, the cameras may be configured tohave tip and/or tilt adjustment such that the attitude or orientation ofthe camera may be adjusted. The line of sight or optical axis of thecameras can thereby be adjusted to, for example, be directed moredownward into the surgical site or be directed less into the surgicalsight and more level or angled in different lateral directions. Thecamera modules 105 can include sensors or markers for, e.g.,electromagnetic or optical tracking or use encoders, accelerometers,gyroscopes, or inertial measurement units (IMUs) or combinations thereofor any other orientation and/or position sensors, as described in moredetail below. Tracking can provide location and/or orientation of thecameras. The images obtained by the cameras may be stitched together ortiled using image processing techniques. Tracking or otherwise knowingthe relative locations of the sensor can assist in image processing anddisplay formatting.

In various embodiments, pairs of cameras together provide informationfor creating a stereo effect or 3-dimensional (3D) image. Pairs ofcameras, for example, may be included on each of the blades 101 of theretractor 100.

As illustrated, the retractor is configured to hold open tissue so as toproduce an open region or cavity centrally located between the blades.Notably, in various embodiments, this open central region isunobstructed by the retractor. In particular, the central portions ofthe open region would be unobstructed by features of the retractor suchthat the surgeon would have clear access to the surgical site. Thesurgeon could thus more freely introduce and utilize his or her tools onlocations within the surgical site. Additionally, this may enable thesurgeon to use tools with both hands without the need to hold anendoscope.

Also as illustrated, the cameras are disposed on the blades of theretractor such that the cameras face inward toward the surgical sitethat would be held open by the retractor blades. The cameras in thisexample would be disposed about the central open region held open by theretractor blades so as to provide views from locations surrounding thesurgical site. The camera thus would face objects within the surgicalsite such as structures on which tools would be used by the surgeon tooperate.

In this particular example, the cameras on two of the blades face eachother such that the leftmost blade and the cameras thereon would be inthe field-of-view of the cameras on the rightmost blade and vice versa.The cameras on the leftmost blade may be anti-parallel to the cameras onthe rightmost blade and have optical axes oriented at an angle, θ, of180° with respect to each other. The cameras on the remaining blade maybe directed orthogonally to the other two blades and thus have opticalaxes directed at an angle, θ, of 90° with respect to each other.Retractors with cameras can be reaffixed to a frame or mountingstructure during a procedure and the cameras can reorient themselveswith respect to relative position within an array of the cameras throughtheir communication protocol with the aggregator and video switchingunit.

In some embodiments, the field-of-views of the different cameras, andhence the images produced by the different cameras, may overlap. Imageprocessing may be employed to yield increased resolution at the regionsof overlap. Likewise, the number of sensors used may be increased toprovide increased field-of-view and/or resolution. Likewise, cameraswith overlapping images can be electronically magnified thereby makingtheir images adjacent rather than overlapping.

A minimally invasive spine surgery can use a tubular retractor having acircular working space with a diameter of approximately 25 mm. Theretractor contains blades, fingers, or at least one barrier such ase.g., a tube that holds tissue back to maintain open the surgical site.Multiple cameras located on the retractor at locations within thesurgical field or in very close proximity thereto, e.g., within 75 mm ofthe surgical opening, can provide a useful viewpoint for the surgeon.The cameras may for example be located on the blades, fingers, tubularbarrier, or other portion of the retractor close to the surgical fieldor within the patient and the surgical field. The cameras may includepairs of cameras arranged and/or oriented to provide stereo and thus 3Dimaging or single CMOS camera chips with dual optics to provide stereo.The cameras may be located at various locations in relation to surgicaldevices, for example, the cameras can be located proximally and distallyalong or near a retractor, wherein the location of the cameras can beconfigured to facilitate both the progression of surgery and an enhancedview or view selection of an area of interest. Tubular Retractor

FIG. 2A is a schematic illustration of a tubular retractor and animaging insert including an illumination assembly and a camera module. Atubular retractor 10650 is sized and configured to receive an insert10652 therein, which includes an illumination assembly 10654 and acamera module 10600. In the illustrated embodiment, the camera module10600 is slidably received within the insert 10652, allowing for thecamera module 10600 to be raised and lowered (i.e. advanced distally orretracted proximally) with respect to the insert 10652. The illuminationassembly 10654 in the illustrated embodiment takes a curvilinear shape,forming a C-shape as seen in plan view (for example, from the top inFIG. 2A). An optical fiber input port 10656 is configured to receive anoptical fiber line such as an optical fiber bundle which delivers lightto the illumination assembly. Interior light guides or fibers carryreceived light from the input port 10656 to output ends disposed at thedistal end 10658 of the illumination assembly 10654. In use, lightoutput from the distal end of the illumination assembly 10658 canilluminate the field of view to be imaged by the camera module 10600.

In the embodiment of FIG. 2A, a single camera module 10600 is disposedwithin the insert 10652. However, in other embodiments, more cameramodules 10600 can be coupled with the insert 10652. For example, asillustrated in FIG. 2B, a retractor 10650 has received therein an insert10652 which includes an illumination assembly 10654 and four cameramodules 10600. As seen in cross-section, four outputs 10658 of theillumination assembly are interspersed between adjacent camera modules10600.

FIGS. 3A-D are schematic illustrations of a tubular retractor assemblywith an imaging insert received therein. FIGS. 3A-B show sideperspective views with FIGS. 3C-D showing top and bottom views,respectively. FIG. 3E shows an enlarged detail view of the distal end ofthe tubular retractor assembly with imaging insert received therein. Theinsert 10652 is received within tubular retractor 10650, with a proximalhead 10660 of the insert 10652 resting above the tubular retractor16050. The insert comprises a restraint configured to prohibit theinsert from passing completely into the working channel of theretractor. The proximal head 10660 can be wider than the distal portionof the insert 10652 to thereby restrain the insert 10652 from passingcompletely into the tubular retractor 10650. In some embodiments, whenthe proximal head 10660 abuts the top of the tubular retractor 10650,the distal end of the insert 10652 is substantially aligned with adistal end of the tubular retractor 10650 (see FIG. 3E). In someembodiments, other restraints can be used. For example, in someembodiments the restraint can include one or more protrusions from theproximal end of the insert, rather than an entire proximal head portion.In some embodiments, the restraint can include a ridge on the insertcorresponding to a groove in the retractor, wherein the groove isconfigured to receive the ridge and to allow the insert to be slidablyengaged with the retractor, while limiting the relative positions of thetwo. In some embodiments, the restraint can similarly include a groovein the insert corresponding to a ridge on the retractor.

In various embodiments, the retractor may assume other shapes, and neednot be tubular. For example, the retractor 16050 may be rectangular,triangular, elliptical, or may have one or more openings on a side. Anupper ring 10662 on the top of the proximal head 10660 includes aplurality of slots 10664 configured to receive flex cables 10608therein. The flex cables are described in more detail herein. In theillustrated embodiment, two flex cables 10608 are provided, eachdirected to a different one of the slots 10664. Associated with eachslot 10664 is a rotatable knob 10666 which, when actuated, causes theflex cable 10608 to be fed into or out of the insert 10652. Withactuation of the rotary knob 1066, therefore, the associated flex cable10608 can be raised or lowered within the insert 10652, nearer orfurther from the distal end 10668. In other embodiments, differentactuation mechanisms may be used to lower or raise the flex cables. Bylowering or raising the flex cables 10608, the cameras disposed on thedistal ends thereof (as shown in FIGS. 6A-C, for example) are movedcloser or further from the distal end 10668. In some embodiments, arestraining bar may be provided within the proximal head 10660 to ensurethat upon raising the flex cable 10608 (i.e. proximally retracting theflex cable 10608), the flex cable 10608 does not bend towards theworking space of the retractor.

A plurality of connectors are provided on the proximal head 10660 of theinsert 10652, including an optical fiber input port 10656, a fluid port10670, and an air port 10672. The fluid port 10670 and air port 10672can provide fluid, such as saline, and air to the cameras disposed onthe flex cables 10608 for cleansing, drying, etc., as describedelsewhere herein. In some embodiments, the insert can additionallyinclude a port for aspiration, for example for removal of blood, saline,or other fluids from the surgical site. A rack 10674 is provided thatsupports the cables attached to the ports 10652, 10670, and 10672 aswell as the flex cables 10608. Within the interior of the insert 10652,a plurality of illumination fibers 10676 extend downward along thelength of the insert 10652. The illumination fibers 10676 carry lightfrom the optical fiber input port 10656 and emit the light out of thedistal ends of the illumination fibers 10676, as shown in FIG. 3E. Theshape and dimensions of the illumination fibers 10676 can be configuredto provide appropriate illumination for imaging (e.g., directionalityand uniformity), while also preserving working space within theretractor. As shown, the illumination fibers 10676 can have asubstantially rectangular cross-section, such that the width 10678 ofthe illumination fibers 10676, which extend along the circumference ofthe insert 10652, is longer than the depth 10680, which extends radiallyinward from the insert 10652. In some embodiments, the ratio of thewidth to the depth can be between about 1.25 and 5, between about 1.5and 4, or between about 2 and 3. In some embodiments, thecross-sectional shape of the illumination fibers 10676 can be curved,for example semi-annular. Light passing along the illumination fibers10676 propagates along their lengths until being emitted from the distalend. In use, the emitted light illuminates a surgical site. In someembodiments, an optical element (e.g., prism, mirror, lens, etc.) can beappended to the distal end of the illumination fiber 10676 to shape ordivert the beam of light emitted from the illumination fiber 10676.

In some embodiments, an insert comprises an upper support configured torest above a retractor. The proximal head of the insert 10660 shown inFIG. 3B, for example, comprises such an upper support. The support isconfigured to receive camera modules within, thereby guiding the cameramodules within the interior of the retractor. The retractor and theinsert can define an interior working space, through which tools can beinserted towards a surgical site. In some embodiments, the insert can besubstantially tubular. Optionally, the outer surface 10702 of the insertcan include guides 10704 such as shown in FIG. 4A on the outer surfaceof the insert which contacts the inner surface 10706 of the retractortube. The guides 10704 can provide for some space between the insert andthe inner wall 10706 of the retractor tube. In some embodiments, theguides 10704 are configured to engage with features such ascomplementary shaped features on the inner surface 10706 of the (e.g.tubular) retractor, in some cases allowing for aligned insertion of theinsert with respect to the retractor. For example, the outer wall 10702of the tubular insert can include ridges configured to mate withcorresponding grooves on the inner surface 10706 of the retractor, orvice versa. In some embodiments, the outer surface 10702 of the tubularinsert can be configured to substantially correspond to the innersurface 10706 of the tubular retractor.

The tubular insert can be characterized by a length and a width. Forexample, in the case of a tubular insert in the shape of a hollowcylinder such as a hollow right circular cylinder as shown in FIG. 4B,the length, L, is the length of the cylinder, and the width, W is thediameter of the outer surface of the cylinder. In this embodiment, thewidth, W, is measured at the distal end. Also, the insert comprises anupper support 10708 configured to rest above a retractor. In this case,the length, L, is measured from the distal end of the upper support10708 where the insert is configured to enter into the retractor. Inother embodiments, the tubular insert may assume other shapes, and neednot be right circular cylindrical. For example, the tubular insert asseen from a cross-section orthogonal to the length (and z-axis) may beannular, elliptical, rectangular, or other shape. The cross-section maybe semiannular forming half of an annulus or other fractional parts ofan annulus, such as ⅓, ¼, ⅔s etc. Similarly, the cross-section may formparts of an ellipse, rectangular, or other shape.

Likewise, in some embodiments, the tubular insert as seen from thecross-section orthogonal to the length thereof (and to the z-axis) maybe partitioned into separate components. For example, as illustrated inFIG. 4C, two semi-annular pieces 10710 may be disposed adjacent to oneanother or abut one another to form the substantially tubular insert. Insome embodiments, such as shown in FIG. 4D, three or more separatepieces 10710 may be positioned adjacently to provide the substantiallytubular shape. In some embodiments, such separate pieces can be retainedtogether by a support structure such as the upper support 10708 shown inFIG. 4B. In other embodiments, the separate pieces may be insertedseparately into the retractor. In some embodiments, each separate piecemay be configured to mate with retention features on the retractor, tomaintain the separate insert piece in place.

Similarly, in some embodiments, the insert may be semi-annularcorresponding to only a portion of the inner surface 10706 of thetubular retractor. For example, one or two of the separate pieces 10710may be excluded from the insert shown in FIG. 4D. Similarly, one of theseparate pieces 10710 may be excluded from the insert shown in FIG. 4C.FIG. 4E shows an example embodiment of an insert having two separatepieces 10710 that cover less than ½ of the inner surface 10706 of thetubular retractor. As illustrated by FIG. 4E, the two portions 10710 canhave different sizes, e.g., arc lengths, as shown in the cross-sectionorthogonal to the length of the insert (and z axis), which is depicted.Thus, the insert need not cover substantially all the inner surface10706 of the tubular retractor. In some embodiments, the outer surface10702 of the insert corresponds only to less than ⅞ of the perimeter ofthe inner surface 10706 of the retractor, in some embodiments less than¾, less than ⅔, less than ½, or less than ⅓ of the perimeter of theinner surface of the retractor. However, in some embodiments, the insertcorresponds to at least ⅓ of the perimeter of the inner surface 10706 ofthe retractor, in some embodiments corresponding to at least ½ of theperimeter of the inner surface of the retractor, in some embodimentscorresponding to at least ⅔, at least ¾, or at least ⅞ of the perimeterof the inner surface of the retractor. Combinations of these ranges aswell as other ranges are also possible.

In some embodiments, the length of the insert may be greater than thewidth of the insert. In some embodiments, this width is measured at thedistal end of the insert although in other embodiments the width may bemeasured at the middle of the length of the insert. In some embodiments,the insert includes an upper support such as 10708 that is wider thanthe distal end of the insert and the length is measured from the distalend of the support structure where the insert enters the retractor. Insome embodiments, the length of the insert may be least 1.1, 1.2, 1.3,1.4, 1.5, 1.6, 1.7, 1.8, or 1.9 the width. In some embodiments, thelength of the insert may be least 2, 3, 4, 5, or more times the width.In various embodiments, however, the length is less than 6, 5, 4, 3, or2 times the width thereof. The insert may be characterized by a centralopening through which tools may be inserted. In some embodiments, thecentral opening has a width, W_(inner), of at least ⅓ of the totalwidth, W, of the insert. In some embodiments, the central opening canhave a width of at least ⅔ of the total width, in some embodiments atleast ¾ of the total width, in some embodiments at least ⅞ of the totalwidth. In various embodiments, the central opening has a width less than15/16, ⅞, ¾, ⅔, or ½ the total width.

In some embodiments, the insert can comprise an upper head portion (suchas the upper support 10708 shown in FIG. 4B) and a plurality of elongatesupport structures for supporting a plurality of cameras and at leastone illumination source (represented by components 10714 in FIGS.4C-4E). Such elongate support structures may correspond to the sections10710 shown in FIGS. 4C-4E or may be disposed thereon. In someembodiments, the insert can comprise an upper head portion and aplurality of elongate support structures for supporting a plurality ofillumination sources 10714 and at least one camera 10714. In someembodiments, access can be provided for tools through the center 10712of the insert to the surgical site. In some embodiments, theillumination sources 10714 can comprise light guides or fibers. In someembodiments, at least one camera 10714 can be disposed at a distal endof an elongate support structure, and at least one camera 10714 can bedisposed proximally to the distal end of an elongate support structure.In some embodiments, a plurality of cameras 10714 disposed on thesupport structures can face inwards towards the working space 10712. Insome embodiments, a plurality of cameras 10714 disposed on the supportstructures can face one another. In some embodiments, two cameras 10714disposed on the support structures are arranged at 180 or more degreeswith respect to one another. As illustrated in FIG. 4D, the cameraspoint in directions having an angle θ of at least 180° with respect toeach other or the normals or optical axes of the cameras are directed atan angle θ of at least 180° with respect to each other. In variousembodiments, the lines of sight, optical axes, or normals of the cameras10714 converge toward a common area. The angle need not be limited to180 or more degrees. In some embodiments, two cameras 10714 disposed onthe support structures are arranged at 90 or more degrees with respectto one another, that is, the cameras 10714 point in directions having anangle θ of at least 90° with respect to each other or the normals oroptical axes of the cameras are directed at an angle θ of at least 90°with respect to each other. Again, as illustrated, the lines of sight,normals or optical axes, of the cameras 10714 converge toward a commonarea. In some embodiments, the two cameras 10714 are arranged at atleast 45 degrees with respect to one another, in some embodiments atleast 30 degrees with respect to one another.

In some embodiments, the plurality of cameras 10714 comprises at leastthree cameras, at least four cameras, at last five cameras, or more. Insome embodiments, the plurality of illumination sources 10714 comprisesat least three illumination sources, at least four illumination sources,at least five illumination sources, or more. In some embodiments, theplurality of cameras 10714 comprises at least two pairs of stereocameras, at least three pairs of stereo cameras, at least four pairs ofstereo cameras, or more. The multiple stereo pairs can be arrange atangles of at least 30°, 45°, 90°, 180° with respect to each other. Insome embodiments, the plurality of elongate support structures comprisesat least three elongate support structures, at least four elongatesupport structures, at least five elongate support structures, or more.In some embodiments, the elongate support structures are configured suchthat when the insert is received within the retractor, the averagedistance separating the outer surface 10702 of the elongate supportstructures and the inner surface of the retractor is less than 5 mm,less than 4 mm, less than 3 mm, less than 2 mm, less than 1 mm or lessand can be touching or be at least 0.2 mm, at least 0.5 mm, at least 1mm, at least 2 mm, at least 3 mm, at least 4 mm in various embodiments.In some embodiments, the elongate support structures are configured toguide the insertion of the insert into the retractor. In someembodiments, at least one of the plurality of cameras 10714 isconfigured to be longitudinally movable along the length of the elongatesupport structure. In some embodiments, at least one of the plurality ofillumination sources 10714 is configured to be longitudinally movablealong the length of the elongate support structure.

In some embodiments, an insert for a retractor provides rigid supportfor one or more camera modules 10714 and one or more light sources10714, wherein the insert is configured to cover at least 25% of thesidewall of the retractor. In some embodiments, the insert is configuredto cover at least 35% of the sidewall, in some embodiments at least 50%,at least 60%, at least 70%, at least 80%, at least 90%, or more (e.g.100%). In some embodiments, the insert is configured to cover at most90% of the sidewall, in some embodiments at most 80%, at most 70%, atmost 60%, at most 50%, or less. In some embodiments, a plurality of suchinserts together covers at least 50% of the sidewall of the retractor,in some embodiments at least 60%, at least 70%, at least 80%, or morebut may be at most 90% of the sidewall, in some embodiments at most 80%,at most 70%, at most 60%, at most 50%, or less. In some embodiments, theinsert can be spaced apart from the sidewall of the retractor, onaverage, by less than about 5 mm, less than about 4 mm, less than about3 mm, less than about 2 mm, or less and can be touching or be, onaverage, at least 0.2 mm, at least 0.5 mm, at least 1 mm, at least 2 mm,at least 3 mm, at least 4 mm in various embodiments. In someembodiments, the insert can be spaced apart from the sidewall of theretractor by on average less than about 10% of the width, W, of theinsert, by less than about 5% of the width of the insert, by less thanabout 3% of the width of the insert, or less but can be spaced apartfrom the sidewall of the retractor by on average at least about 1% ofthe width, W, of the insert, at least about 3% of the width of theinsert, at least about 5% of the width of the insert. In someembodiments the insert is generally disposed against and touches theinner surface 10706 of the retractor. In some embodiments, the pluralityof inserts can together provide a central access 10712 for tools throughthe retractor to a surgical site.

Accordingly, in some embodiments, an insert for a retractor providesrigid support for one or more camera modules and/or one or more lightsources 10714, wherein the insert has a width, W greater than itsthickness, T. In some embodiments, the sidewall 10706 of the insert canbe substantially arcuate or curved. In some embodiments, the sidewall10706 of the insert is flat, linear, and/or planar. The cross-section ofthe insert, orthogonal to the length (and z axis as shown) can besubstantially rectangular. In some embodiments, the width, W, can be atleast twice the thickness, T, in some embodiments at least three times,at least four times, at least five times, or more and may be ten timesor less, five times or less, four times or less, etc. In someembodiments, multiple inserts are configured to be simultaneouslydisposed within the retractor, the inserts together providing a centralaccess 10712 for tools through the retractor to a surgical site. In someembodiments, a system comprises a retractor having inner sidewalls10706, and a conformal insert having a shape corresponding to the innersidewalls of the retractor. In some embodiments, the conformal inserthas a shape corresponding to at least 25% of the inner sidewalls 10706of the retractor. In some embodiments, the conformal insert has a shapecorresponding to at least 30%, at least 40%, at least 50%, at least 75%,or more of the inner sidewalls 10706 of the retractor. In someembodiments, the conformal insert is spaced apart from the innersidewalls 10706 of the retractor by on average less than about 5 mm,less than about 4 mm, less than about 3 mm, less than about 2 mm, orless. In some embodiments, the conformal insert is spaced apart from theinner sidewalls 10706 of the retractor by on average less than about 10%of the width of the insert, by less than about 5%, less than about 3%,or less.

Additionally, in some embodiments, an insert comprises a top headportion 10708 and a plurality of rigid elongate support structures forsupporting proximal and distal cameras 10714 thereon and at least oneillumination source 10714. In some embodiments, the length, L, of thesupport structures that is configured to extend into the retractor isgreater than the width, W. In some embodiments, the length of thesupport structures is at least twice the width, at least three times thewidth, at least four times the width, or more.

Additionally, in some embodiments, an insert comprises a top headportion 10708 and a plurality of rigid elongate support structuresconfigured to receive a camera 10714 and at least one illuminationsource 10714. In some embodiments, the length, L, of the supportstructures that is configured to extend into the retractor is greaterthan the width, W. In some embodiments, the length of the supportstructures is at least twice the width, at least three times the width,at least four times the width, or more.

Camera Modules with Flex Cable

FIGS. 6A-6D are schematic illustrations of a camera module with a flexcable, according to one embodiment. The camera module 10600 includes acamera 10602 disposed at the distal end, enclosed within housing 10604.As shown in FIG. 6B, the camera 10602 includes a sensor 10606 disposedon flex cable 10608. Optics 10610 are arranged over the sensor 10606.The flex cable 10608 is disposed on a stiffener 10612, which can be madeof, for example, stainless steel or other sufficiently rigid material tosupport the flex cable 10608, optics 10610, sensor 10606, etc. In someembodiments, the flex cable 10608 may be overlaid with silicone or otherprotective material and/or potting material. As shown in FIG. 6C,housing 10604 includes a window 10614 through which the image can betaken via optics 10610 and sensor 10606. In various embodiments, thewindow 10614 comprises a sapphire window. In various embodiments, thehousing may comprise a thin wall. In some embodiments, the housing maybe made of electro-formed thin wall stainless steel, and may be laserwelded to the stiffener. As described in more detail below, the entirecamera module 10600 can be moved proximally or distally to obtain thedesired view for imaging.

FIG. 6D illustrates the proximal end 10616 of the flex cable 10608,which includes a plurality of electrical leads 10618 on a tab 10619extending perpendicularly from the longitudinal axis of the flex cable10608. As a result, the L-shaped distal end 10616 can be received withinvertical slots 10620 of the aggregator 10622. When received within thevertical slots 10620, electrical connection is made between the flexcable 10608 and the aggregator 10622. A lid 10624 can be disposed overthe vertical slits 10620 to protect the upward facing electricalconnections. An open channel 10626 in the aggregator 10622 can beconfigured to receive fluidics lines, fiber optic cables, or othercomponents. In the illustrated embodiment, the open channel 10626 isdisposed beneath the electrical connector slits 10620. However, in otherembodiments the open channel may be arranged next to or above theelectrical connector slits.

In some embodiments, the cameras on the retractor blades or flexiblecable can be tilted, for example, upward or downwards or sideways orcombinations thereof. The cameras can be tilted to achieve differentorientations of the camera. For example, in some embodiments, thecameras can be tilted with the use of hydraulic balloon, diaphragm, orbellows actuated pistons thereby orienting the camera in differentpositions relative to the retractor blade. The tilt of the camera can bechanged prior to or during a surgical procedure. For example, thecameras can be positioned on a stage and the stage can be tilted withthe use of hydraulic balloon, diaphragm or bellows actuated pistonsthereby orienting the camera in different positions relative to theretractor blade. In some embodiments, the cameras on the retractorblades can be situated on a track that allows the camera to movevertically (and/or laterally) on the retractor blade thereby changingthe position of the camera. Such a vertical position can be set prior tosurgery or during surgery. The positioning may be performed manually orby using an actuator, such as a motor or other actuator.

In some embodiments, the camera module position and orientation withrespect to the retractor can be controlled, for example, remotelycontrolled. The camera may be manipulated to tilt or move vertically orhorizontally with respect to the retractor. Electrical, manualmechanical, or other means can control and/or drive the position ororientation of the camera. In some embodiments, the camera movement canbe provided by an electro mechanical device such as a piezo or otheractuator. In some embodiments, the camera movement can be provided byone or more Micro-Electro-Mechanical System (MEMS) actuators. In someembodiments, however, MEMS devices may encounter limitations with regardto autoclaving and exposure to water.

In various embodiments, the camera modules can be positioned using amovable mechanical device or system that is manually controlled. FIG. 7Aillustrates a cross-sectional view of an embodiment of a flexible jointor hinge 10812 having a camera platform 10811 and a retractor connectorsurface 10811. The flexible joint can be a flexible revolute joint orhinge that allows the camera to move relative to the rigid structure ofthe retractor and/or retractor mounted connection surface 10813. Invarious embodiments, the flexural revolute joint can provide one degreeof freedom such as pitch variation. The flexural element can promotecorrect alignment, may have reduced or no stiction, and may beinexpensive and compact. In some embodiments, the camera platform 10811can have attached push-pull cables, rods or other members 10814. Thepush-pull rods or members 10814 can allow for movement of the camera10811 relative to the retractor blades 10813. The movement of the cameracan result from tension (or pressure) forces exerted on a portion of thecamera platform 10811 which creates flexing of the flexible joint 10812.Once the tension (or pressure) is released, the flexible joint allowsthe camera platform 10811 and camera thereon to return to the unflexedposition.

As illustrated in FIG. 7B, in some embodiments, the cables 10814 (orrods or others members) are connected to a knob or crank 10816positioned at a proximal or top end of the retractor or retractor blade10815. Movement of the knob 10816 creates the force used to actuate thepush-pull cables, rods, or members 10814 and provides the movement andlocking mechanisms for the cables 10814. One set of push-pull cables,rods, or members 10814 can be provided on each side of the cameraplatform 10811 to allow movement about a vertical axis of the joint.Such a configuration can allow for one degree of freedom movement of thecamera and camera platform 10811. In some embodiments, additionalpush-pull cables, rods, or members 10814 can be provided to supportmovement of the camera 10811 in additional directions. For example, asecond set of push-pull cables, rods, or members 10814 can be attachedto the top and bottom portions of the camera platform 10811. Actuationof these cables 10814 can provide movement of the camera platform 10811about the horizontal axis. In some embodiments, a flexural gimbal havingtwo degrees of freedom, such as pitch and yaw, may be used. In someembodiments, the hinge, pivot, or joint can be a ball joint or a jeweledpivot. In some embodiments, the linear motion of the push-pull cable,rod, or member (e.g., the pull motion on a flexible joint) can drive awedge to create angular motion of the camera with respect to theretractor element 10815. In some embodiments, instead of or in additionto a push-pull cable, rod or member, a pull cable, rod or member forpulling (or pushing) can be used with a joint such as a flexuralrevolute joint that has a flexural spring return.

As described above, in some embodiments, the movement is provided withelectrical actuators. Instead of manually turning a knob or crank, forexample, a motor or other electro-mechanical actuator could be used todrive the motion.

Additionally, in some embodiments, the camera can be actuatedpneumatically or hydraulically. Pressurized air or saline can allow forremote actuation of the camera. Bellows or diaphragms may be used toprovide the force necessary to rotate or tilt the camera with respect tothe retractor blade. The pneumatic or hydraulic actuation requires nomotors and has greater compatibility with EM tracking devices asdescribed herein. In some embodiments that do not employ a MEMSactuation device, autoclaving can be employed and water damage issuesare alleviated.

Foot Pedal and Frame

FIG. 8A is a schematic illustration of a surgical visualization systemincluding a foot pedal. In some embodiments, a foot pedal 10801 may beprovided for use with the console 10001. The foot pedal 10801 can bepositioned adjacent to the console 10001 and within the reach of thefoot of a medical professional 10029, 10031 during use. In someembodiments, the foot pedal 10801 can communicate with the console 10001through a connection provided by, for example, a foot pedal cable 10802.When the foot pedal 10801 is depressed, the foot pedal 10801 provides anoutput signal through the foot pedal cable 10802. The output signal canallow for control, movement, actuation, or other functionalitiesprovided by the associated console mechanisms, various of which aredescribed herein. The foot pedal 10801 and foot pedal cable 10802 canprovide for communication with the console 10001 to allow for themedical professional to remotely control the various functionsassociated with the console 10001. In some embodiments, the cable 10802can be excluded and communication between the foot pedal 10801 andconsole 10001 can be provide, for example, wirelessly.

The foot pedal 10801 can activate or control the functions associatedwith or connected to the console 10001. During surgery, a medicalprofessional 10029, 10031 can depress or otherwise activate the footpedal 10801. In some embodiments, such activation can provide foractivation or communication with an associated hydraulic, mechanical, orelectrical system. For example, the activation of the foot pedal 10801by depressing the foot pedal 10801 can start a hydraulic circuit similarto one that can also control the tools or camera cleaning components asdescribed herein. The foot pedal can be used to control the hydraulicsystem. In some embodiments, the foot pedal 10801 can be used to operatesurgical devices such as a surgical retractor, camera, or tools such as,Kerrison, forceps, or any other tools as disclosed or described herein.Additionally, thereon some embodiments, the foot pedal can be used tocontrol fluid and/or air pulses over the surface of the cameras or foruse in the surgical area.

In some embodiments, the foot pedal 10801 can be a proportional footpedal that allows for proportional control of the associated mechanism.For example, the speed or force applied by a tool can be proportional tothe depression or force applied by the medical professional to the footpedal 10801. Similarly, increasing depression of the foot pedal, forexample, can close the tool by a proportional amount. Additionally, insome embodiments, surgical impedance feedback can be incorporated asdescribed previously. Increased resistance felt by the surgical tool canbe communicated to the operator by an increased resistance in thedepression of the foot pedal. This allows the medical professional toreceive a tactile response to the resistance of the tool even though thetool is operated by a remote foot pedal.

One or more foot pedals can be utilized to control one device. Themultiple foot pedals can provide for control of different parameters ofa device. In some embodiments, the one or more foot pedals can eachoperate or control different tools. One foot pedal can operate onedevice while a second foot pedal can control a second device. Thereforethe medical professional can utilize two tools actuated by foot pedalsand allowing his or her hands to be free to perform other functions. Invarious embodiments, one or more of these foot pedals may beproportional foot pedals and may provide tactile feedback.

As illustrated in FIG. 8B, in some embodiments, the multiple foot pedals10801 can be located within the same frame 10803. The single frame 10803housing the multiple foot pedals 10801 can provide for easy movement andpositioning of the foot pedals in a close proximity to the medicalprofessional without unnecessary crowding or reaching required by thesurgeon. In various embodiments, one or more of these foot pedals may bea proportional foot pedal and may provide tactile feedback.

Driver Boards Inside the Console

In some embodiments, the console 10001 can contain driver boards forcontrolling various surgical tools. Some embodiments further comprise afoot pedal, which can send a signal to a driver board in the console10001 upon user actuation of the foot pedal. Upon receiving a signalfrom the foot pedal, the driver board can control various parameters ofthe surgical tools, such as power. In some embodiments, the foot pedalis proportional, so that the degree to which the foot pedal is depressedcorrelates to the amount of power supplied to a surgical tool and/or theresult, e.g., the amount of movement, the speed, etc. Thus, for example,if the foot pedal is depressed to its maximum displacement (e.g., to thefloor) the driver board can cause the surgical tool to operate atmaximum power. Continuing the example, if the foot pedal is depressed tohalf its maximum displacement, the driver board can cause the surgicaltool to operate at half the maximum power.

In some embodiments, the console 10001 can contain an ultrasonic driverboard for driving an ultrasonic tissue aspirator. The ultrasonic tissueaspirator can be used for various surgical procedures and operations,such as brain tumor debulking. Brain tumor debulking can be facilitatedby various aspirator hand pieces, which can also be driven by theultrasonic driver board inside the console 10001. The aspirator handpieces can be reusable according to some embodiments. In someembodiments, ultrasonic power can be controlled via a proportional footpedal. For example, depressing the foot pedal can send a signal to theultrasonic driver board in the console 10001 to deliver power to theultrasonic tissue aspirator in proportion to the degree to which thefoot pedal is depressed.

In some embodiments, one foot pedal may control both the aspirationlevel and the ultrasonic power level of the ultrasonic tissue aspirator.In some embodiments, depressing the foot pedal may cause the aspirationlevel and the ultrasonic power level to increase simultaneously andproportionally. In other embodiments, the aspiration level and theultrasound power level may not increase simultaneously and/orproportionally. For example, a first depression of the foot pedal (e.g.,depressing the foot pedal to half its maximum displacement) may increasethe aspiration level while the ultrasound power level remains constant.A second depression of the foot pedal (e.g., depressing the foot pedalfrom half its maximum displacement to its full maximum displacement) mayincrease both the aspiration level and the ultrasound levelproportionally. In other embodiments, the sequence may be reversed.Thus, a first depression of the foot pedal may increase the aspirationlevel and the ultrasound power level proportionally, and a seconddepression of the foot pedal may increase the aspiration power levelwhile the ultrasound power level remains constant. In variousembodiments, software may be provided which can be programmed to controlthe relation between the aspiration level and the ultrasound power levelthat is output when the foot pedal is depressed.

In some embodiments, the ultrasonic driver board may introduce noise,which may disturb the video output signal from the cameras on theretractors. In order to minimize noise introduced to the video cameraoutput signal by the ultrasonic driver board, the ultrasonic driverboard can be shielded and separated from the other electronic componentsin the console, such as the flex cables from the cameras on theretractors. Additionally, the surgical visualization system may includea filter configured to filter out the unwanted components of the videofrom the cameras. Because the noise introduced by the ultrasonic driverboards may be at a particular frequency, a notch filter can be used, thenotch being at a dominant frequency of the noise (e.g., at 23 kHz and/or36 kHz). This notch filter may be included with electronics for thesurgical visualization system such as electronics on the console and maybe in electronics on the console arm such as the distal end of theconsole arm, e.g., in the CIB. The notch filter may comprise one or moredigital or analog filters. In some embodiments, the notch filter isincluded in a processor. In some embodiments, the notch filter isincluded with amplifier circuitry.

In some instances, a phase-locked loop can be employed to remove noiseintroduced by the ultrasonic driver board. In particular, thephase-locked loop can be used to synchronize a version of the outputsignal from the ultrasonic driver board with the output video signal ofthe cameras, such that the noise contribution to the video signalresulting from the ultrasonic driver board can be removed or at leastreduced. In various embodiments, for example, the ultrasonic driverboard generates an oscillating signal at a particular frequency (e.g.,at 23 kHz and/or 36 kHz) as well as potentially some harmonics. Thisoscillating signal can introduce noise having similar frequencycomponents into the video signal produced by the camera. In an effort tocancel out this noise, an output signal of the ultrasonic driver boardat this frequency (and possibly including the harmonics) can be comparedto the video output signal from the cameras, or a facsimile thereofusing the phase-locked loop. The phase-locked loop can then lock ontothe frequency and phase of the two signals. The phase-locked loop wouldthen be used to produce an output similar to the ultrasonic driver boardsignal but with a frequency and phase that matches the output videosignal of the cameras. This phase-locked signal can then be subtractedfrom the video signal output by the cameras so that noise in the videointroduced by the ultrasonic driver board can be removed or at leastreduced. In some embodiments, an adaptive filter can be used to providethe correct amplitude of the noise to be subtracted out of the videosignal.

The ultrasonic driver board, in some embodiments, drives an ultrasonictissue aspirator, which can be coordinated with a precision suctionsystem. The precision suction system can be used for various surgicaloperations. For example, the suction system can be used near fragileveins with precise control of very low vacuum levels. The suction systemcan also be used near ruptured aneurysms where high vacuum levels can beused for suctioning blood. Suctioned blood and tissue can be transferredto disposable canisters according to some embodiments. In addition, thesuction system can be used with conventional medical devices, such asreusable and disposable cannulas. The suction system can also becoordinated with the ultrasonic tissue aspirator.

In some embodiments, the power and/or vacuum level of the precisionsuction system can be controlled via a proportional foot pedal. Someembodiments include a proportional foot pedal for the precision suctionsystem, and a separate proportional foot pedal for the ultrasonic tissueaspirator. In other embodiments, one proportional foot pedal can be usedto control both the ultrasonic tissue aspirator or other tools and theprecision suction system. In these embodiments, an auditory command, agesture, a touch input, or the like can be used to select the surgicaltool controlled by the proportional foot pedal.

Some embodiments of the console include a radiofrequency (RF) driverboard in the console 10001. The RF driver board can be configured todrive bipolar radiofrequency (RF) coagulation and cutting tools as wellas bipolar forceps. In some embodiments, the coagulation and cuttingtools are disposable. In order to reduce charring and sticking, in someembodiments the bipolar forceps can be irrigated with pressurized salinefrom the console 10001. Saline irrigation can further be utilized toclean the bipolar forceps as well as other surgical tools.

A proportional foot pedal can be used to control the bipolar RFcoagulation and cutting tools and the bipolar forceps. For example,depressing the proportional foot pedal can send a signal to the RFdriver board causing the RF tools to operate with more or less power, inproportion to the degree to which the foot pedal is depressed. Someembodiments include a proportional foot pedal in communication with theRF driver board and a separate proportional foot pedal in communicationwith the ultrasonic driver board. Other embodiments include one footpedal in communication with both the RF driver board and the ultrasonicdriver board.

According to some embodiments, the RF driver board can support multiplemodulation formats. Thus, one RF driver system included in the consolecan support multiple RF surgical tools and their respective modulationformats. The RF driver board, may for example, comprise a processorand/or other electronics configured to provide signals with the desiredformatting. Amplifiers may be used as well to provide the desiredformatting. In various embodiments, a format is selected and theprocessor or electronics adjusts so as to output the suitable format.The format selected may vary for different surgical tools, tool types,manufacturer's etc. Selection may be provide by the surgeon, atechnician, a nurse, or another medical professional. In someembodiments, the selection may be provided by RFID, EEPROM or othercoding associated with the tool such that the presence or connection ofthe tool activates selection of the proper format. The electronics inthe RF driver reconfigures the output to be consistent with the selectedformat. Thus, despite different modulation formats for different RFsurgical tools, only one RF driver system, which may be included in theconsole, may be used to drive the RF surgical tools.

As discussed above, in various embodiments, footpedals may be used toprovide control, such as proportional control of electronics,hydraulics, tools, suction, and other functions or combinations offunctions. Foot pedals are beneficial because control can be providedwithout employing the hands, which can be used for other aspect of thesurgery. In certain embodiments, however, other types of controls otherthan foot pedals may be used. In some embodiments, the RF driver boardmay introduce noise, which may disturb the video output signal from thecameras on the retractors. In order to reduce of minimize noiseintroduced to the video camera output signal by the ultrasonic driverboard, the ultrasonic driver board can be shielded and separated fromthe other electronic components in the console, such as the flex cablesfrom the cameras on the retractors. Additionally, the surgicalvisualization system may include a filter configured to filter out theunwanted components of the video from the cameras. Because the noiseintroduced by the RF driver board may be at a particular frequency, anotch filter can be used, the notch being at a dominant frequency of thenoise. For example, in some embodiments, the RF driver board mayintroduce to the video camera output signal a noise frequency of about300-500 kHz with a modulation scheme of approximately 30 kHz and otherharmonics that may be introduced by, for example, changes in theimpedance of the tissue surgical site. Therefore, in these embodiments,the notch filter may be configured to filter out from the video cameraoutput signal the dominant frequency, which may be about 500 kHz. Insome embodiments, the noise introduced by the RF driver board may be atrelatively high frequencies, such as 400 kHz to 3.5 MHz. Therefore, insome embodiments the surgical visualization system can include a lowpass filter to remove these relatively high frequency noise signals fromthe video camera output signal.

This notch filter or low pass filter may be included with electronicsfor the surgical visualization system such as electronics in the consoleand may be electronics in the console arm such as the distal end of theconsole arm, e.g., in the CIB. The notch filter or low pass filter maycomprise one or more digital or analog filters. In some embodiments, thenotch filter or low pass filter is included in a processor. In someembodiments the notch filter or low pass filter is included withamplifier circuitry.

In some instances, a phase-locked loop can be employed to remove noiseintroduced by the RF driver board. In particular, the phase-locked loopcan be used to synchronize a version of the output signal from the RFdriver board with the output video signal of the cameras, such that thenoise contribution to the video signal resulting from the RF driverboard can be removed or at least reduced. In various embodiments, forexample, the ultrasonic driver board generates a signal at a particularfrequency (e.g., at 500 kHz) as well as potentially some harmonics. Thissignal can introduce noise having similar frequency components into thevideo signal produced by the camera. In an effort to cancel out thisnoise, an output signal of the RF driver board at this frequency (andpossibly including the harmonics) can be compared to the video outputsignal from the cameras, or a facsimile thereof using the phase-lockedloop. The phase-locked loop can then lock onto the frequency and phaseof the two signals. The phase-locked loop would then be used to producean output similar to the RF driver board signal but with a frequency andphase that matches the output video signal of the cameras. Thisphase-locked signal can then be subtracted from the video signal outputby the cameras so that noise in the video introduced by the RF driverboard can be removed or at least reduced. In some embodiments, anadaptive filter can be used to provide the correct amplitude of thenoise to be subtracted out of the video signal. Paragraphs [0883]-[0898]and claims 111-115 from each of U.S. Prov. App. No. 61/880,808, U.S.Prov. App. No. 61/920,451, U.S. Prov. App. No. 61/921,051, U.S. Prov.App. No. 61/921,389, U.S. Prov. App. No. 61/922,068, and U.S. Prov. App.No. 61/923,188 are incorporated by reference herein.

Distal Proximal Camera With Prism

As illustrated in FIG. 5A, in various embodiments the cameras located onthe retractor can be configured to provide stereo imaging. A pair oflenses or lens trains may be included with a pair of optical sensors (orseparate portions of a single optical sensor). The lenses form images onthe image sensor(s). The pair of lens or lens trains and opticalsensor(s) can mimic a pair of eyes providing stereo acquired depthperception.

In various embodiments, the cameras can additionally include one or moredistal optical elements (e.g., a prism) configured to redirect anoptical path or primary optical axis from being parallel with amechanical axis (e.g., a longitudinal axis of a cable forming part of acamera module) to point inward relative to the mechanical axis. Theinward pointing angle can be at least 0.1° and/or less than or equal toabout 90°, at least about 15° and/or less than or equal to about 75°, orat least about 30° and/or less than or equal to about 45°. The opticalsubassembly can include one or more proximal optical elements (e.g., aprism) to fold the optical path of the optical assembly to be parallelwith the mechanical axis (e.g., the longitudinal axis of the cable).

In various embodiments, the optical subassembly can include distaloptical elements (e.g., prisms) to further separate stereo optical pathsto approximate an inter-pupillary distance, which may in someembodiments, be similar to that provided by an operating roommicroscope. For example, for a close working distance (e.g., 10 mm, 15mm, 20 mm, 25 mm) the adjacent right eye and left eye separation can beplaced side by side with the lens trains side by side with frontcollection surface side by side. In some embodiment, a single imagesensor can include masking to separate portions of the sensor for therespective lens trains. In various embodiments, a center-to-centerdistance between the front collection surface, for the respective leftand right imaging optics, divided by the above working distancesapproximates the convergence physicians are familiar with such as whileusing such operating room microscopes. For larger working distances(e.g., approaching between about 75 mm and 100 mm), the center-to-centerseparation can be increased by using deviating prisms configured toseparate the front collection surface and/or entrance pupils. See, forexample, the stereo optical assemblies 11200 a, 11200 b can be usedrespectively as proximal and distal cameras mounted on a retractor.

With regard to masking the sensor, in some embodiments, portions of theimage sensor can be electronically mapped (e.g., through electronics orimage processing methods) as left and right sides of the image sensorfor the respective left and right channels of the stereo camera optics.As discussed above, in some embodiments, a center-to-center distancebetween the left and right sides, divided by the working distance, canbe adjusted to approximate the convergence accustomed to by a surgeon.In some embodiments, the parameters are selected to approximate theconvergence typical operating room microscopes. The electronic masks canbe used to create left- and right-eye views using circular electronicmask openings, square electronic mask openings, or some other shape forthe electronic mask openings. In some embodiments, the electronic maskopenings can be movable along an axis of the sensor (e.g., a vertical orhorizontal axis) to control convergence. The distance between theelectronic mask openings can be controlled by a user through userinterface elements on the display, such as a graphical user interface.The size of the masks (e.g., a diameter), can be electronically fixed ina non-transitory storage medium (e.g., an EPROM), and may be fixed oradjustable. The distance between the electronic mask openings can beconfigured according to one or more targeted or suitable effects suchas, for example, alignment error correction, dead pixel masking, or thelike.

FIG. 5A illustrates example embodiments of stereo optical assemblies11200 a, 11200 b comprising lenses and prisms. The stereo opticalassemblies 11200 a, 11200 b include image sensors 11205 a, 11205 bdivided into a left-side and a right-side for producing correspondingleft-side and right-side stereo images. The stereo optical assemblies11200 a, 11200 b include first redirection optics 11210 a, 11210 b tofold the optical axis along a path that is substantially perpendicularto the plane of the image sensors 11205 a, 11205 b. The stereo opticalassemblies 11200 a, 11200 b include imaging optics such as lens trains11215 a, 11215 b comprising one or more optical elements configured toimage a scene onto the image sensors 11205 a, 11205 b. These one or moreoptical elements may comprise one or more lenses, which may opticallycomprise one or more rod lenses. The stereo optical assemblies 11200 a,11200 b include second redirection optics 11220 a, 11220 b configured todefine or provide a convergence angle, a field of view, and/or a line ofsight for the stereo optical assemblies 11200 a, 11200 b.

In some embodiments, the second redirection optics 11220 a can beconfigured to redirect the left- and right-side optical axes from a paththat is substantially parallel with a mechanical axis of the structurewith which it is associated to an axis that is between about 10 degreesand about 75 degrees, between about 20 degrees and about 60 degrees, orbetween about 30 degrees and about 45 degrees from coaxial with thatmechanical axis. In some embodiments, the second redirection optics11220 b can be configured to separate left and right optical paths to anapproximate inter-pupilary distance to provide stereo imaging forthree-dimensional viewing. In certain embodiments, the secondredirection optics 11220 b can be configured to separate optical pathsto an approximate inter-pupilary distance of a typical operating roommicroscope. For relatively close working distances (e.g., about 10 mm,15 mm, 20 mm, or 25 mm), the adjacent right-eye and left-eye separationon the image sensor, with an optical physical or electronic mask, can besufficient for the inter-pupilary separation distance. For longerworking distances (e.g., at least about 75 mm and/or less than or equalto about 100 mm), the second redirection optics 11220 b can be used tochange the effective separation of the left- and right-eye views. Insuch a case, the line of sight of the proximal cameras can be decreasedto be between about 30 degrees and about 50 degrees for viewing into, asopposed to within, a surgical or anatomical site. Accordingly, cameraoptics providing a line of sight of between about 30 degrees and about50 degrees may be used in such cases. In various embodiments, the leftand right views in side-by-side arrangement and adjusting the spacingtherebetween to provide the desired convergence can reduce keystonedistortions that would be cause by alternatively tilting the pair ofcamera views with respect to each other to provide the desiredconvergence.

As discussed above, in some embodiments, the stereo optical assemblies11200 a, 11200 b can be used respectively as proximal and distal camerasmounted on a retractor. The stereo optical assemblies 11200 a, 11200 bcan be mounted at the same azimuthal angle with respect to the surgicalsite, e.g., both at 12 o'clock, 3 o'clock, 6 o'clock, 9 o'clock, orpoints in between. The stereo optical assemblies 11200 a, 11200 b can beconfigured to have their optical axes generally align with the gravityvector when mounted to a retractor. In some embodiments, the angles ofthe optical axes can be different from one another, or non-parallel.

Stereo Camera Design

As discussed above, in various embodiments a single two-dimensionalimage sensor can be employed for a stereo camera. Separate optics, e.g.,lens trains, for left (L) and right (R) channels can be directed to thesingle two-dimensional image sensor as shown in FIG. 5B. Thetwo-dimensional image sensor may comprise, for example, a CCD or CMOSdetector array. A pair of prisms or separate portions of a single prismmay be employed to direct the beam from the lens train (not shown) forthe respective left (L) and right (R) channels onto the single detectorarray.

Alternatively, more than a single chip can be employed. In particular,first and second two-dimensional detector arrays can be disposed toreceive the left (L) and right (R) channels respectively as illustratedin FIG. 5C. In the embodiment shown, first and second prisms receivelight from first and second lens trains (not shown) corresponding to theleft and right channels, respectively of the stereo camera. The firstand second prisms turn the light onto the front face of the respectivefirst and second two-dimensional detector array (e.g., CCD or CMOSdetector arrays). Light is thus received at the front face of thedetectors for converting into an electrical signal and transforming anoptical image into data to create an electrical image.

In the configuration shown, the first detector array is disposed above(e.g., in the +Y direction) and is offset laterally (e.g., in the Xdirection) with respect to the second detector array. Additionally, theactive area of the chip for the first detector array faces (e.g., in the−Y direction) while the active area of the chip for the second detectorarray faces (e.g., in the +Y direction.)

Likewise, the first and second prisms are oriented oppositely as well asbeing disposed laterally with respect to each other. For example, thefirst prism is disposed in the X direction with respect to the secondprism. Moreover, in the embodiment shown, the first and second prismscomprises right angle prisms, however, the first prism is flippedupside-down with respect to the second prism. Each of the first andsecond prisms have primary reflective faces that receive light from thelens train and direct the light to the active region of the 2D detectorarray chip. Because the second 2D array is below the prism while thefirst 2D array is above the prism, the reflective surface of the twoprisms are orthogonal to each other. Accordingly, the reflective surfaceof the second prism reflects incoming light from the optics traindownward (e.g., in the −Y direction) to the detector array thereunder.In contrast, the reflective surface of the first prism reflects incominglight from the optics train upward (e.g., in the +Y direction) to thedetector array thereover.

Advantageously, this arrangement enables the two detector array chips tobe in close proximity of each other providing a more compact design.Variations are possible. For example, the prisms need not be right angleprisms. For example, the primary reflective surface need not be at anangle of 45 degrees with respect to the front face of the 2D sensorarrays. Additionally, different types of prisms and/or reflectivesurfaces can be employed. Other variations are also possible.

In comparison to the embodiment shown in FIG. 5B, in some cases, theembodiments shown in FIG. 5C offers the ability obtain higherresolution. For example, the full set of available usable pixels for twoseparate higher resolution chips, one for each of the left and rightchannels, may be employed in the configuration shown in FIG. 5C.Conversely, for the configuration shown FIG. 5B the pixels of the singlechip are shared by the two channels thereby reducing the resolution byhalf as half of the pixels are used for each of the left and rightchannels.

Example Camera/Sensor Designs

As discussed above with reference to FIGS. 5A and 5B, a single sensormay be employed to obtain left and right images of a stereo camera pair.The sensor may be partitioned into areas to receive light from left andright imaging optics that produces left and right images on the activearea of the sensor. A mask can be employed to partition the active areaof the sensor into these left and right areas for receiving the left andright images. In some embodiments, stereo optics with left and rightlens trains image onto the single sensor that is coupled to a processorconfigured to collect left and right images from the sensor at far leftand right edges of sensor and superimpose those images to form a stereoimage with same convergence as eye. The mask can be moved to collectlight from different parts of the sensor. In some embodiments, the maskcan be moved dynamically to accommodate variable optical parameters ofthe camera optics, for example, variable focus and working distance,which coincides with varying divergence. The mask may be implemented viasoftware and corresponds to which pixels of the sensor to exclude fromimage formation. Conversely, the software implemented mask determineswhat pixels are used to collect image data. Separate left and right openportions of the mask where light to form the image is collected can bespaced farther apart or closer together depending on the desiredconvergence angle, focus, work distance, etc.

In other designs, it may be possible to have a chip with two spacedapart active regions thereon corresponding to left and right imagechannels. A single chip in a single package can comprise semiconductorand be patterned such that two spaced apart regions of pixels may becreated to receive light from left and right lens trains. The space mayinclude in some embodiments electronics or dead space. The space betweenthese regions may not be active areas for collecting and sensing light.The spacing may accommodate for example the space needed for the two(left and right) lens trains or other physical components. A single 45°turning prism or a pair of 45° turning prisms may be employed toredirect light from said lens trains onto the front face and activeregions of the sensor.

Methods of Surgery

A surgeon makes an incision for access into the body and introducestools initially into the body. As the tools progress into the surgicalsite, the surgeon may use certain embodiments of the cameras asdisclosed herein on a retractor. In certain cases, the surgeon will usethe proximal retractor cameras initially and the distal retractorcameras thereafter as the surgical tool(s) passes deeper into thesurgical site, for example, passing through proximal regions of theopening in the body into more distal regions into the surgical site. Thevarious cameras can be employed to guide advancement of the tool intothe desired depth in the body and into the surgical site. Similarly,with removal of the instruments, this process may be reversed (forexample, the distal camera may be used more after relying on theproximal camera).

Various embodiments of the system may additionally be configured toprovide for the same convergence angle for each of the stereo cameras,for example, the stereo cameras on the retractor, including possiblyboth proximal and distal stereo cameras. Also, if a stereo camera ismounted on a surgical tool, such as for example, a Kerrison, this toolcamera too may have the same convergence angle. Having a similarconvergence angle from one stereo camera to another should provide amore comfortable viewing experience for the surgeon.

The convergence angle is determined by the separation of the left andright cameras of a stereo camera pair that make up the stereo camera. Asdiscussed herein, these cameras obtain images of the object fromdifferent perspectives akin to the human's eyes separated by aninterpupillary distance. The convergence angle is also determined by thedistance to the object, for example, the working distance of the camera.In particular, the convergence angle depends on the ratio of thedistance separating the left and right cameras and the working distanceof the camera pair to the object.

The human brain and eye react to depth cues resulting at least in partfrom the convergence. Likewise images produced by stereo cameras havinga convergence angle (based on interpupillary distance and workingdistance of the stereo camera pair), will provide depth cues to viewersof those images. As the surgeon may be transitioning between viewingimages from the proximal and distal cameras on the retractor, and one ormore cameras on surgical tools, the surgeon will receive depth cues fromthese different cameras. In various embodiments, the stereo cameras havethe same convergence so as to avoid introducing changes among the depthcues as the surgeon moves from viewing video from one of the cameras toanother and to yet another and back, for example.

In certain embodiments, stereo cameras may be configured to be adjustedto provide the same convergence angle. For example, the stereo camera orcameras on the retractor and/or surgical tool may be adjustable toprovide the same convergence. As referred to above, these cameras mayinclude proximal and/or distal cameras on the retractor.

As discussed above with reference to FIGS. 5A and 5B, a mask associatedwith the two-dimensional detector array may be adjusted to provide forthe desired convergence angle. For example, a single sensor such asshown in FIGS. 5A and 5B may be employed to obtain left and right imagesof a stereo camera pair. The sensor may be partitioned into areas toreceive light from left and right imaging optics that produces left andright images on the active area of the sensor. A mask can be employed topartition the active area of the sensor into these left and right areasfor receiving the left and right images. In some embodiments, stereooptics with left and right lens trains image onto the single sensor thatis coupled to a processor configured to collect left and right imagesfrom the sensor at far left and right edges of sensor. Using left andright displays, the left and right images are provided to left and righteyes of the surgeon or assistant, whose brain forms a third stereo imagetherefrom. The separation of the left and right areas that receive theleft and right images establishes the interpupillary distant thattogether with the working distance controls the convergence angle.Accordingly, the mask can be moved to collect light from different partsof the sensor potentially increasing or decreasing this interpupillarydistance. Moreover, in some embodiments, the mask can be moveddynamically (increasing or decreasing this separation) to accommodatevariable optical parameters of the camera optics, for example,convergence, as well as variable focus and working distance. The maskmay be implemented via software and corresponds to which pixels of thesensor to exclude from image formation. Conversely, the softwareimplemented mask determines what pixels are used to collect image data.Accordingly, separate left and right open portions of the mask wherelight to form the image is collected can be spaced farther apart orcloser together depending on the desired convergence angle.

Such a mask need not be limited to embodiments such as those disclosedin FIGS. 5A and 5B. Embodiments such as show in FIG. 5C, which employtwo detector array chips, can also have one or more masks that can bemoved to accommodate for different optical parameters includingconvergence, work distance, focal length, etc. One or both twodimensional detector arrays can have masks having open regions that arelaterally translated to change the distance separating the locationswhere light is collected, thus changing, for example, the convergenceangle. As discussed above, the mask may be implemented via software andcorresponds to which pixels of the sensor to exclude from imageformation. Conversely, the software implemented mask determines whatpixels are used to collect image data. Separate left and right openportions of the mask where light to form the image on separaterespective chips is collected can be spaced farther apart or closertogether depending on the desired convergence angle. In someembodiments, a mask is disposed on one chip while the other chip doesnot have such a dynamically moveable mask. By moving the mask on the onechip, however, optical parameters such as convergence can be altered.For example, if the chip on the left has a dynamic mask, the openportions in the mask can be spaced farther apart or closer to the chipon the right depending on the desired convergence angle.

Accordingly, the mask can be adjusted, for example, one or more openingstherein can be translated, to provide for the same convergence betweenstereo cameras on the retractor and/or surgical tool. For example, amask on one or more stereo cameras (e.g., a stereo camera pair on asurgical tool, proximal and/or distal stereo cameras on a retractor,etc.) may be changed or reconfigured, for example, by moving one or moreopenings therein, to provide the same convergence angle. Consequently,using the reconfigurable mask with movable aperture(s), stereo camerapairs on retractors or surgical tools may be provided with a similarconvergence. By maintaining the same convergence for the differentcameras, the depth cues provided the surgeon can be maintain relativelyconstant despite viewing images from different stereo cameras (e.g.,proximal retractor camera, distal retractor camera, surgical toolcamera, etc.). As a result, a more comfortable viewing experience may beprovided.

In certain embodiments, the stereo camera may additionally provideadjustable focus. One or more actuators may be included that areconfigured to translate one or more lenses in the camera optics thatimages the surgical site onto the two-dimensional detector array tochange the focus of the camera. These actuators may be drivenelectrically in some embodiments although different types of actuatorscould be employed. These actuators can be included in the package thatsupports the camera and is disposed on the retractor. Advantageously,cameras on retractors (in contrast for example to endoscopes) haveavailable space lateral to the imaging lenses (e.g., in the radialdirection) in which such actuation devices can be located. The resultmay be that the lateral dimensions (e.g., in x and y) exceed thelongitudinal dimensions (z), however, surgical access to the surgicalsite would not be impeded by utilization of the space surrounding thelenses in the lateral or radial directions.

In various embodiments, when the focus is changed using the actuator,the mask may be reconfigured or changed as discussed above. For example,one or more open region or aperture in the mask through which light isdirected to the left and/or right channel can be shifted laterally toincrease or decrease the convergence angle. In this manner, theconvergence angle of the stereo camera with the adjustable focusdisposed on the retractor or surgical tool can be altered to be thesame. Constant convergence angle for different stereo cameras can beprovided even if such cameras include an adjustable focus. Both thefocus and the mask can be changed as needed to provide the desired focusand convergence angle.

Incorporating an adjustable focus enables a camera lens having a smallerdepth of focus to be employed. Such a camera lens will have a largernumerical aperture and smaller F-number than a similar lens thatproduces a larger depth of focus. Some benefits of the larger aperturelens are increased light collection and resolution.

Adjustment of Camera Focal Lengths and/or Orientation

In various embodiments, the cameras on the retractor provide focusedimages of a surgical tool tip. Furthermore, various embodiments includesoftware that maintains focus on the surgical tool tip, even while thetool moves about the surgical site. In particular, when the tool movesin any direction (e.g., laterally, vertically, or a combination ofboth), the software can be configured to maintain the retractor cameras'focus (or other camera's focus) on the tool tip by changing a focallength and/or orientation of the cameras. In various embodiments, theposition and/or movement of the tool tip can be determined through atracking device on the surgical tool, e.g., on or at the tool tip.

When the tool tip moves about the surgical site, the distance betweenthe cameras imaging the surgical tool tip and surgical tool tip changes,according to some embodiments. Furthermore, the distance between onecamera and the tool tip, and the distance between another camera and thetool tip, can be different. For example, when the instrument tip movesabout the surgical site laterally, it can move closer to one camera andfarther away from another camera. As the tool tip moves the movement cancause the tool tip to become out of focus. In some embodiments, a footpedal can be actuated (e.g., a foot pedal can be depressed), to enableadjustment of the focal distance and/or orientation of the cameras andthereby maintain focus of the target image. For example, actuation of afoot pedal can cause the retractor cameras to maintain focus on thesurgical tool tip. Further, in order to account for the varyingdistances between each of the cameras and the tool tip, whilemaintaining focus of the tool tip, various embodiments can includesoftware that changes the focus of the cameras as the tool tip changesposition.

In addition, in the case where the cameras include electricallycontrolled transducers or actuators to vary their orientation, thesoftware can be configured to change the orientation of the cameras(e.g., tip, tilt, etc.) using the actuators, as the tool tip movesvertically into or out of the surgical site. For example, if the tooltip moves deeper into the surgical site, the software can be configuredto increase the angle of the cameras in a downstream direction (e.g.,deeper into the surgical site). As another example, if the tool tipmoves out of the surgical site, the software can be configured toincrease the angle of the cameras in an upstream direction. In variousembodiments, the software can be configured to change the orientation ofthe camera with movement of the surgical tool tip, such that thecameras' view follows movement of the tool tip. This software may forexample cause a processor to drive the actuators that are configured tomove the cameras.

In some embodiments, one or more cameras on the surgical tool cansimilarly be configured to have focal adjustment and orientationadjustment in order to maintain focus of the surgical site. In addition,tracking information can be received via a tracking device on thesurgical tool. Based on this tracking information, when the surgicaltool moves, the software can reposition the focal length and/ororientation of the tool camera(s) in order to maintain focus on thesurgical site. Thus, the cameras can maintain focus on the surgical sitewhile the surgical tool changes positions.

The images of the surgical tool and/or the surgical site can bedisplayed on a surgical visualization system display such as one or moresurgeons display and/or assistants displays according to someembodiments. Those images can also be displayed on a graphical userinterface according to some embodiments. In some embodiments, agraphical user interface is displayed on the surgical visualizationdisplay. In other embodiments, a separate display is provided for thegraphical user interface. In either case, the images of the surgicaltool and/or the surgical site can be displayed on the surgicalvisualization system display(s) as well as a graphical userinterface(s). In some embodiments, the movement of the tool or toollocation is used to control selection of the camera images that aredisplayed on the displays. Additionally, actuation of a foot pedal cancause the surgical tool cameras to maintain focus on the surgical site.In some embodiments, actuation of one foot pedal device can cause boththe retractor cameras and the surgical tool cameras to maintain focus oftheir target.

Fluorescence Imaging

In various embodiments, images or information in addition to video fromthe cameras on the retractor can be presented via the display. Forexample, in some embodiments fluorescence information can be displayed.Cameras that image in different wavelengths, such as infrared, couldimage the surgical site or objects contained therein. In someembodiments, features could be made to fluoresce, for example, byinjecting fluorescent chemical and illuminating the area with light thewill induce fluorescence. Such a technique may be useful to identifyand/or highlight the location and/or boundaries of specific features ofinterest such as tumors, etc. The fluorescence or other wavelength ofinterest may be detected by the cameras on the retractor or one or moreother cameras. In some embodiments, images produced by fluorescence orother wavelengths of interest are superimposed on one or more imagesfrom cameras on the retractor or other camera(s). Filtering could beprovided to remove unwanted wavelengths and possibly increase contrast.The filter can remove excitation illumination. In some embodimentsemission image content, (e.g., fluorescing tissue) can be parsed andsuperimposed on image content that is not emitting (e.g., tissue that isnot fluorescing), or vice versa. In various embodiments, such as wherethe fluorescing wavelength is not visible (e.g., for fluorescence in theinfrared), an artificial color rendition of the fluorescing content canbe used in place of the actual fluorescing color so as to enable thefluorescing tissue to be visible.

Kerrison

In various embodiments, the console can be equipped with a hydraulicand/or pneumatic system that can be employed to drive hydraulic andpneumatic tools.

FIGS. 9A-C illustrate an embodiment of a Kerrison 1900 that can beoperated hydraulically. The Kerrison 1900 can include a proximal handleportion 1918. The proximal handle portion 1918 can be attached orotherwise connected with a distal handle portion 1923. In someembodiments, the proximal handle portion 1918 includes a grip 1915(e.g., a pistol grip or other ergonomic grip). The proximal handleportion 1918 can be configured to rotate about a handle axis 1927(shown, e.g., in FIG. 9B9B) with respect to the distal handle portion1923.

In some embodiments, the Kerrison 1900 includes a base 1930. The base1930 can include a cutting portion at a distal end (e.g., the left endof FIG. 9B9B). The base 1930 can be fixed axially (e.g., parallel to thehandle axis 1927) with respect to the distal handle portion 1923 and/orwith respect to the proximal handle portion 1918. In some embodiments,the base 1930 and/or distal handle portion 1923 are rotatable about thehandle axis 1927 with respect to the proximal handle portion 1918.

As shown in FIG. 9C, the proximal handle portion 1918 can define anactuation chamber 1919. In some embodiments, at least a portion of theactuation chamber 1919 along a length of the actuation chamber 1919parallel to the handle axis 1927 has a substantially constantcross-section. In some embodiments, at least a portion of the actuationchamber 1919 has a circular cross-section.

In some embodiments, the distal handle portion 1923 defines a distalactuation chamber 1917. In some embodiments, the distal actuationchamber 1917 has a cross-section with substantially the same shapeand/or size as a cross-section of at least a portion of the actuationchamber 1919.

The Kerrison 1900 can include a piston 1920. The piston 1920 can beoperably coupled with and/or attached to a Kerrison top portion 1928.For example, the piston 1920 can be a unitary part with orattached/adhered/welded to the Kerrison top portion 1928. In someembodiments, the piston 1920 and top portion 1928 are connected via areleasable connection (e.g., a protrusion-slot connection). The piston1920 can be fixed axially (e.g., parallel to the handle axis 1927) withrespect to the top portion 1928. In some embodiments, the piston 1920 isfixed rotationally with respect to the top portion 1928 (e.g., rotationabout the handle axis 1927).

The top portion 1928 can include a cutting edge on the distal end of thetop portion 1928. The cutting edge of the top portion 1928 can beconfigured to operate with the cutting portion of the base 1930 to cutmedical material (e.g., bone and/or other tissue). In some embodiments,the top portion 1928 is connected to the base 1930 via atrack-protrusion engagement. For example, the top portion 1928 caninclude a protrusion configured to slidably engage with a track in thebase 1930. Engagement between the track of the base 1930 and theprotrusion of the top portion 1928 can limit the movement of the topportion 1928 with respect to the base 1930 to the axial direction (e.g.,parallel to the handle axis 1927).

In some embodiments, the piston 1920 is configured to fit within theactuation chamber 1919 and/or within the distal actuation chamber 1917.For example, the piston 1920 can have a first guide portion 1921 aconfigured to fit snugly within the actuation chamber 1919 (e.g., fitsuch that movement of the first guide portion 1921 a within theactuation chamber is substantially limited to axial movement androtational movement about the handle axis 1927). In some embodiments,the piston 1920 includes a second guide portion 1921 b. The second guideportion 1921 b can be configured to fit snugly within the distalactuation chamber 1917. Axial movement of the piston 1920 can be limitedby interaction between a radially-inward projection 1913 of the proximalhandle portion 1918. For example, proximal axial movement of the piston1920 can be limited by interaction between the second guide portion 1921b and the radially-inward projection 1913. In some embodiments, distalaxial movement of the piston 1920 is limited by interaction between thefirst guide portion 1921 a and the radially-inward projection 1913.

The distal handle portion 1923 can include a distal opening 1905. Thedistal opening 1905 can be sized and/or shaped to accommodate passage ofthe top portion 1928 therethrough. In some embodiments, the top portion1928 is sized and shaped to fit snugly within the distal opening 1905.For example, the top portion 1928 can have a non-circular cross-sectionsized to substantially match a cross-section shape of the distal opening1905. In some embodiments, the top portion 1928 is rotationally lockedto the distal handle portion 1923 via interaction between the distalopening 1905 and the top portion 1928. In some such embodiments, thegrip 1915 can be rotated relative to the top portion 1928 and the base1930. In some embodiments, sensors and/or optical devices (e.g.,cameras, CMOS sensors, etc.) can be attached to the proximal handleportion 1918 such that the relative alignment of the sensors and/oroptical devices with respect to the handle portion 1918 remainsconsistent independent of rotation of the top portion 1928 and base 1930with respect to the handle portion 1918.

As illustrated in FIG. 9C, an actuation element 1916 can be positionedwithin the actuation chamber 1919. In some embodiments, the actuationelement 1916 is an inflatable and/or disposable bag or balloonconfigured to be inflated/deflated with physiological saline. In someembodiments, the actuation element 1916 is a bellows (e.g., stainlesssteel metal bellows such as those manufactured by BellowsTech, Inc.).The actuation element 1916 can be configured to exert an axial force onthe piston 1920 (e.g., a force upon the first guide portion 1921 a) tomove the piston 1920 in the distal axial direction. The Kerrison 1900can include a biasing structure 1924 (e.g., a spring or other resilientstructure) configured to bias the piston 1920 in the proximal axialdirection. For example, the biasing structure 1924 can provide a returnforce to return the piston 1920 to push the piston 1920 in the proximalaxial direction when the axial force from the actuation element 1916 isreduced and/or removed.

In some embodiments, the Kerrison 1900 includes a return valve (notshown) configured to introduce physiological saline so as to providecompression to the actuation element 1916. The return valve may, forexample, allow injection of pressurized gas into the distal actuationchamber 1917 or in the region of the proximal actuation chamber 1919forward the first guide portion 1921 a. The fluid introduced via thereturn valve can be used to move the piston 1920 in the proximaldirection. In some such embodiments, the Kerrison 1900 does not includea biasing structure 1924.

The actuation element 1916 can be fluidly connected to a conduit 1914through which physiological saline can be input into and pulled out fromthe actuation element 1916. In some embodiments, hydraulic controlsassociated with the actuation element 1916 are operated via a footpedal. Such embodiments can allow for greater dexterity for the user ofthe Kerrison 1900 by reducing the operating variables controlled by theKerrison 1900 handle portions 1918, 1923. Elastomeric and/orproportional valves can be used to enhance the responsiveness of theKerrison 1900 to operation of the foot pedal (see, e.g., FIGS. 43E-43F).

Additionally, with reference to FIGS. 9D-9G, the Kerrison can have avariety of cutting head configurations. For example, with reference toFIGS. 9E-9G, in any of the embodiments disclosed herein, the cuttinghead 1728 can have a circular shaped cross-section (as in FIG. 9E), thecutting head 1728 can have a C shaped cross-section (as in FIG. 9F) or aclosed D shaped cross-section (as in FIG. 9G). Other shapes and designsare possible.

Additionally, in any of the Kerrison embodiments described herein, thefixed cutting surface 1730 can be generally vertically oriented. Asshown in FIG. 9D, the fixed cutting surface 1730 can also be angulated(for example, angled at approximately 45 degrees, or from approximately35 degrees or less to 55 degrees or more).

In the tool embodiments disclosed herein, including without limitationthe Kerrison, the cutting surface or top surface of the tool can bebayonetted. The bayonetted structure of the tool can allow the tool tobe inserted into the surgical area without interfering or obscuring theviews of the surgical site or overhead views of the surgical field. Thebayonet style tool can be utilized for the Kerrison, forceps, scissors,or other tools described herein. The bayonet configuration can beadvantageous for small surgical sites or external viewing of thesurgical site. The bayonet feature reduces the area obscured by the toolwithin the surgical site.

In any of the tool embodiments disclosed herein, including withoutlimitation the Kerrison, the housing supporting or comprising the toolcan be configured to have a port or lumen therein arranged to facilitatethe removal of tissue and bone extracted from the surgical site. Forexample, the Kerrison can have a side port or opening located proximalof the cutting head 1728, though which cut tissue can be removed (e.g.,pushed through port or opening as cutter withdraws and Kerrison returnsto the default position). In some embodiments, a source of suction, or asource of saline and suction, can be supplied to the port. Additionally,the removal port or lumen of the housing can also support a mechanicalremoval mechanism, such as but not limited to a screw type auger (whichcan be hydraulically actuated, via for example a gear motor, gerotor, orvane motor 1512 discussed above), to facilitate removal of bone debrisand extracted tissue from the surgical site. In some embodiments, theremoved tissue can be extracted to a waste reservoir supported by ortethered to the housing of the tool. In another embodiment, the movablecutting head of the Kerrison can be a generally cylindrical tube thatcan be actuated (in the matter described above) to slidably move againstthe fixed cutting surface 1730. For example, said cylindrical tube canbe slidable within an outer housing of the Kerrison when a force isexerted thereon via the expansion of the second inflatable element 1716,as discussed above.

Additionally, in any of the tool embodiments disclosed herein, includingwithout limitation the Kerrison, the housing supporting or comprisingthe tool can be configured to have a suction port and a source of salineso that the tool and/or the surgical site can be flushed with saline andthe saline and debris can removed via the suction line simultaneously orsequentially with the flushing. In some embodiments, the saline can beprovided through the conduit used to provide saline to the secondinflatable element, through the same or a different lumen of suchconduit.

Additionally, the saline source or conduit and/or the suction source orconduit can be separate from the tool so that it can be independentlypositioned. In some embodiments, the saline source or conduit and/or thesuction source or conduit can be tethered to the tool.

Any of the hydraulic system embodiments disclosed herein can beconfigured to incorporate or use any suitable surgical tools, includingwithout limitation scissors, micro-scissors, forceps, micro-forceps,bipolar forceps, clip appliers including aneurysm clip appliers,rongeur, and, as described, Kerrison tools.

Turbine

Another tool is a drill which can be driven by a hydraulic turbine. Thetool can be driven by a hydraulic turbine. In some embodiments, asillustrated in FIGS. 10A and 10B, a hydraulic turbine 2070 includes aturbine housing 2071. In some cases, at least a portion of a nozzleframe 2072 is housed within the turbine housing 2071. In someembodiments, stator vanes can be used in conjunction with and/or inplace of the nozzle frame 2072. The nozzle frame 2072 can include one ormore turbine nozzles 2073. In some embodiments, the turbine nozzles 2073are positioned in a circumferential array, as illustrated in FIG. 10A.Each of the turbine nozzles 2073 can have a nozzle inlet 2074 and anozzle outlet 2075. In some embodiments, the nozzles 2073 havesubstantially constant cross-sectional areas from nozzle inlet 2074 tonozzle outlet 2075 (e.g., drill hole-type nozzles). For example,circular nozzles can be used.

The relative areas of the nozzle inlet 2074 and the nozzle outlet 2075can vary. For example, the nozzle outlet 2075 can have an area that isgreater than or equal to approximately 125% of the area of the nozzleinlet 2074 and/or less than or equal to about 600% of the area of thenozzle inlet 2074. In some embodiments, the area of the nozzle outlet2075 is approximately 300% of the area of the nozzle inlet 2074.

As illustrated in FIG. 10B, the profile of the nozzle 2073 can widenbetween the nozzle inlet 2074 and the nozzle outlet 2075. The rate atwhich the turbine nozzle 2073 widens between the nozzle inlet 2074 andthe nozzle outlet 2075 can vary. For example, the nozzle 2073 can flareout in the direction of the nozzle outlet 2075. In some embodiments, theprofile of the nozzle 2073 narrows between the nozzle inlet 2074 and thenozzle outlet 2075. In some embodiments, the nozzles 2073 havesubstantially constant cross-sectional areas from nozzle inlet 2074 tonozzle outlet 2075 (e.g., drill hole-type nozzles). In some embodiments,the nozzle inlet 2074 can be tapered or flared in such that an openinginto the nozzle inlets 2074 is wider or larger than a midsection of thenozzles 2073.

In some embodiments, physiological saline is directed through the nozzleframe 2072 toward an impeller 2076. The impeller 2076 can include aplurality of impeller blades 2077 around the outer periphery of the hubof the impeller 2076. The impeller blades 2077 can rotate within a bladecavity 2077 a. (See FIG. 10C.) The impeller 2076 can be integral with orotherwise rotationally coupled with an output shaft 2079 for driving thetool 2082, which can be a drill or other rotational tool. The outerdiameter of the hub of the impeller 2076 can be smaller than the outsidediameter of the array of hydraulic nozzles 2073. For example, the outerdiameter of the hub of the impeller 2076 can be greater than or equal toapproximately 15% of the outer diameter of the hydraulic nozzles 2073and/or less than or equal to approximately 75% of the outer diameter ofthe hydraulic nozzles 2073. In some cases, the outer diameter of theimpeller 2076 can be greater than or equal to 0.5 inches and/or lessthan or equal to approximately 1.5 inches. Many variations sizes andrelative sizes of the components of the hydraulic turbine 2070 and itssubcomponents are possible.

In some cases, the impeller blades 2077 are oriented at an angle offsetfrom the central axis of the impeller 2077. The hydraulic nozzles 2073can be configured to turn the flow of physiological saline from an axialdirection A to nozzle direction 2078 as the flow is passed through thenozzle frame 2072 toward the impeller 2076. The nozzle direction 2078can be selected to be at an angle θ_(T) offset from axial A such thatthe nozzle direction 2078 is substantially perpendicular to the faces ofthe impeller blades 2077. The closer nozzle outlets are to the plane ofthe impeller blades 2077 and the more radially-directed the flow fromthe nozzles, the more torque can be imparted upon the impeller blades2077. For example, the nozzle outlets can be positioned close to theimpeller blades 2077 in the axial direction and can direct physiologicalsaline at a highly-radial angle toward impeller blades 2077 whosesurfaces are close to parallel to the rotation of axis of the impeller2076.

In some cases, utilizing a plurality of circumferentially-distributedturbine nozzles 2073 to drive a plurality of impeller blades 2077 canincrease the torque output of impeller 2076 as compared to aconfiguration wherein only one turbine nozzle 2073 is utilized. In somesuch configurations, the outer diameters of the nozzle frame 2072 andimpeller 2076 can smaller than a single-nozzle configuration of equaloutput torque.

In some embodiments, the hydraulic turbine 2070 can be configured tooperate at rotational speeds of 40,000 rpm to 60,000 rpm, though higherand lower rpm values may be possible. In some embodiments, the hydraulicturbine is configured to operate at rotational speeds of 100,000 rpm.The hydraulic turbine 2070 can be configured to operate at operatingpressures between 70 psi and 190 psi, though greater and lesseroperating pressures are possible. In some embodiments, the operatingpressure of the hydraulic turbine 2070 is designed to be approximately120 psi.

As illustrated in FIG. 11, an impeller 2076′ can be designed to havebucket-shaped impeller blades 2076′. The bucket-shaped impeller blades2077′ can be oriented at an angle of approximately 45° from the axialdirection A. Many variations of the impeller blade 2077′ angles arepossible. Additionally, many different shapes of blades 2077 arepossible, such as Pelton or Turgo shaped blades.

As illustrated in FIG. 10C, the hydraulic turbine 2070 can be designedto collect the physiological saline that has already impacted theimpeller blades 2077, 2077′ (hereinafter 2077 for simplicity). Forexample, an exhaust angle can be calculated to represent the angle atwhich physiological saline reflects off of the impeller blades 2077after impact with the impeller blades 2077. One or more vacuum ports2093 can be positioned on or in the turbine housing 2071 to extract thefluid F1 that is reflected off of the impeller blades 2077 and redirectthe fluid F1 into a bypass channel 2095. In some embodiments, the vacuumsource can be an external pump (e.g., a peristaltic pump) or the vacuumcan be the result of a Venturi effect created by the diversion of fluid.For example, in some embodiments, the vacuum source can be provided bydiverted, high velocity fluid F2 directed to bypass the impeller 2076.In some embodiments, one or more ports 2093 in the hydraulic turbinehousing 2071 (e.g., on the side of the housing closer to the impeller2076 than to the nozzle frame 2072) can create fluid communicationbetween the reflected fluid F1 in the blade cavity 2077A and thediverted high velocity fluid F2 in the bypass channel 2095. The pressuredifferential between the two fluid bodies (e.g., lower pressure in fluidF2 and higher pressure in fluid F1) will pull the reflected fluid F1 outof the housing 2071 and into the diverted fluid path 2095. Removal ofthe reflected fluid from the housing 2071 can increase the performanceof the turbine 2070 by reducing the viscous drag on the impeller fromundiverted fluid F1. For example, the viscous frictional losses thatwould be otherwise incurred from interaction between the reflected fluidF1 and the impeller 2076 and/or output shaft 2079 can be reduced. Thediverted high velocity fluid F2 and scavenged reflected fluid F1 can bediverted back to the cassette 2020 for re-pressurization. In someembodiments, scavenging reflected fluid F1 and diverting it back to thecassette 2020 can reduce the amount of physiological saline required tooperate the tools and/or other components of the system. In someembodiments, the housing 2071 can include one or more ports open toambient. Such ports can be configured to receive pressurized air orother pneumatic gas. In some embodiments, the turbine 2070 is configuredto operate as a dual hydro/pneumatic turbine configured to operate viahydraulic power and pneumatic power or a continual variance of hydraulicand pneumatic power. A controller or switch(s) can be used to vary theamount of hydraulic fluid or pneumatic air or gas are applied to theturbine. In some embodiments, the controller or switch(es) allow theuser to increase pneumatic gas or air and decrease hydraulic or viceversa. The pneumatic gas or air and hydraulic fluid can be provided byoutput ports on the display console. Likewise, the controller and/orswitch(es) may be on the controller or remotely located.

In some embodiments, multiple impellers 2076 (e.g., multiple turbinewheels) can be utilized in the same turbine housing 2071. In some suchembodiments, the overall diameter of the turbine 2070 and/or some of itscomponents can be reduced relative to a single-impeller turbine 2070without sacrificing output torque.

Some instruments such as surgical tools use torque or mechanical forceto translate manual input into tool actuation. For example, a Kerrisonfor bone removal generally includes a handle mechanically coupled to ahead including a stationary portion and a movable portion. When a usersqueezes the handle, the movable portion moves closer to the stationaryportion in a cutting manner (e.g., in a shearing manner), for example toremove bone by trapping the removed bone between the stationary portionand the movable portion (e.g., within a channel between the stationaryportion and the movable portion). Other examples of tools include ananeurysm clipper, a rongeur, forceps, scissors, and the like, althoughmany other hand-operated tools are known to those skilled in the art.Referring again to the Kerrison, the pace and force of the squeezingtranslates to the pace and force of the cutting, and this phenomenon isalso applicable to other hand-operated tools. This translation can bedisadvantageous, for example varying based on each user, being too slowor too fast or having variable speed, lacking force or imparting toomuch force or having variable force, etc. Additionally, periodic use ofsuch manually operated tools (e.g., during a lengthy operation orprocedure) can lead to hand fatigue of the surgeon or user. Manualactuation leads to inadvertent movement of the tool tip.

The hydraulic system may also be used for other purpose such as cleaningoptics and/or cooling light emitters for illuminating a surgical site.

Pop-Off Valve For Camera Cleaning/Cleaning Based On Detection Of Blood

In some embodiments, a fluid reservoir can be fluidly connected to oneor more fluid outlets (e.g., nozzles) configured to wash opticalcomponents (e.g., cameras, LEDs, and/or other components disposed in thesurgical site that can be dirtied by blood, bodily fluids, or debris).The fluid reservoir can be fluidly connected to the fluid outlets via ahydraulic manifold in console. In some embodiments, one or more valves(e.g., proportional, elastomeric, and/or on/off valves) can bepositioned in the fluid path between the fluid reservoir and the fluidoutlets.

For example, a pulsing valve (e.g., a pop off valve) can be positionedin a fluid path between the fluid outlets and the fluid reservoir. Insome embodiments, the pulsing valve is disposable. The pulsing valve isconfigured to open when a pressure threshold is reached. In variousembodiments, the valve closes once the pressure returns to below thethreshold. In some embodiments, the operation of the pulsing valve canproduce a substantially square wave fluid pulse. The pulsing valve canbe used to provide short duration liquid pulses to wash optics such asthe camera optics. One benefit of such a pulse is the reduction of imagedistortion that would result in interruption of usable video streamprovided to the surgeon. Such degradation of the video can be caused byflowing liquid across the camera for a noticeable period of time duringwhich the image is distorted. In various embodiments, the pulsing or popoff valve can be located so as to wash all the cameras at the same time.The pulsing valve, for example, can be located upstream to where theline splits into different fluid outlets to clean different cameras.

To activate the pulsing valve, the pressure may be increased beyond thethreshold for opening the pulsing valve. The pulsing valve may, forexample, be connected to a high pressure source of fluid via a valve.The valve can be opened sufficiently to provide increased pressurebeyond the threshold value resulting in a pulse of liquid from thepulsing valve. In certain embodiments the liquid pulses are producedperiodically. For example, a processor may cause the valve to be openedperiodically based on a schedule programmed into the processor orselected by the user via the processor. In some embodiments, liquidpulses are produced when blood or other obstruction is detected. Theintensity level of the camera can be monitored to determine whenvisibility is compromised. In various cases, the color of the lightreaching the camera can be analyzed to determine, for example, thatblood is obstructing or impairing vision of the cameras and to therebytrigger pulse washing. The processor could be utilized to analyze theimage signal and determine whether pulse washing is to be initiated. Insome embodiments, attenuation of the red wavelength in comparison toother wavelengths such as green may indicate that blood is on the cameraand reducing the amount of light entering the camera.

A three-way valve can also be employed. The three-way valve can operateto permit fluid from the fluid reservoir or gas such as pressurized gasfrom a pump to access the fluid outlets via the pulsing valve. Thethree-way valve can be configured to selectively shut off supply offluid from the fluid reservoir and provide instead gas (e.g.,pressurized gas from a pump). In some embodiments, shut off of fluidfrom the fluid reservoir to the fluid outlets can reduce the likelihoodof “dribbling” or other inadvertent leakage of liquid from the fluidoutlets onto the optical components. The pressurized air stream used todry the camera optics can carry away any residual liquid that wouldotherwise dribble onto the camera at a later time. Depending on thedesign, the three-way valve can be positioned upstream or downstream ofthe pulsing valve. In some embodiments, positioning the three-way valvedownstream of the pop off valve may further reduce dribbling.

In some embodiments, gas can be directed to the fluid outlets. Forexample, the pneumatic assembly can be configured to direct pressurizedpneumatic gas (e.g., air) to the fluid outlets. The pneumatic gas can besupplied by a pump or other source of pressurized pneumatic gas. Forexample, an air pump can be positioned within the hydraulic manifold inthe console or elsewhere in the hydraulic pressure circuit therein. Insome embodiments, a pulsing valve is configured to open when a pressurethreshold in the pneumatic gas is reached. The pulsing valve can producea substantially square pneumatic gas wave. In some embodiments, thepressurized air output by the fluid outlets creates a squeegeeing effectwherein the pneumatic gas effectively squeegees the optical componentsto dry them.

Suction Cassette

In some embodiments, a console can include a medical suction system. Asillustrated in FIG. 12, for example, a medical suction system 12000 caninclude a suction cassette assembly 12020. In some embodiments, thesuction cassette assembly 12020 and/or components thereof aredisposable. The suction cassette assembly 12020 can include a pluralityof ports 12022. The ports 12022 can be configured to facilitate fluidcommunication between fluid lines external to the suction cassetteassembly 12020 and fluid lines internal to the suction cassette assembly12020.

In some embodiments, the medical suction system 12000 includes a firstsuction line 12080 a. The medical suction system 12000 can, in someembodiments, include a second suction line 12080 b. The suction cassetteassembly 12020 can be configured to utilize the first and second suctionlines 12080 a, 12080 b simultaneously and/or in isolation.

As illustrated, the medical suction system 12000 can include a vacuumsource 12040. In some embodiments, the vacuum source 12040 is a hospitalvacuum source. In some embodiments, the vacuum source 12040 is a pump.Many variations are possible. In some embodiments, the vacuum source12040 is fluidly connected to the suction cassette assembly 12020 via afirst vacuum line 12044 a. In some embodiments, a second vacuum line12044 b connects the vacuum source 12040 to the suction cassette 12020.The medical suction system 12000 can be configured to utilize the firstand second vacuum lines 12044 a, 12044 b simultaneously and/or inisolation.

In some embodiments, the medical suction system 12000 includes a storagetank 12060. The storage tank 12060 can be configured to store bloodand/or other tissue/fluids. In some embodiments, the storage tank 12060is fluidly connected to a waste line (not shown) or other disposal line.The storage tank 12060 can be connected to the suction cassette assembly12020 via a first storage line (e.g., storage inlet line 12062 a). Insome embodiments, the storage tank 12060 is connected to the suctioncassette assembly 12020 via a second storage line (e.g., storage outletline 12062 b).

The suction cassette assembly 12020 can include an intermediate tank12024. The intermediate tank 12024 can be housed at least partiallywithin the suction cassette assembly 12020. In some embodiments, theintermediate storage tank 12024 is fluidly connected to the secondsuction line 12080 b. The intermediate storage tank 12024 can beconfigured to store medical and/or bodily fluids/tissues (e.g., blood,saline, bone matter).

In some embodiments, the intermediate storage tank 12024 is fluidlyconnected to the storage tank 12060. In some embodiments, a pump 12026(e.g., a peristaltic pump or other fluid pump) can be positioned on thefluid line between the intermediate storage tank 12024 and the storagetank 12060. The pump 12026 can be configured to pull material from theintermediate storage tank 12024 into the storage tank 12060. In someembodiments, the pump 12026 is configured to reduce the likelihood offluid/bodily material transfer from the storage tank 12060 to theintermediate storage tank 12024. The pump 12026 can be configured topermit large portions of tissue (e.g., bone portions, muscle portions,and/or other tissue) to travel from the intermediate storage tank 12024to the storage tank 12060. In some embodiments, the pump 12026 ispositioned at least partially within the suction cassette assembly12020.

The medical suction system 12000 can include one or more filters 12022.In some embodiments, the filters 12027 a, 12027 b are hydrophobic and/oranti-microbial. One or more of the filters 12022 can be positionedwithin the suction cassette assembly 12020. In some embodiments, afilter 12022 is positioned in the fluid line between the storage tank12060 and the vacuum source 12040. Such a filter 12022 could beconfigured to reduce the likelihood that liquid and/or pathogens couldpass from the storage tank 12060 to the vacuum source 12040. In someembodiments a filter 12022 can be positioned in the fluid line betweenthe intermediate storage tank 12024 and the vacuum source 12040. Such afilter 12022 could be configured to reduce the likelihood that liquidand/or pathogens could pass from the intermediate storage tank 12024 tothe vacuum source 12040.

In some embodiments, one or more valves are positioned on the vacuumlines 12044 a, 12044 b. For example, a first vacuum valve 12042 a can bepositioned on the first vacuum line 12044 a. The first vacuum valve12042 a can be configured to selectively occlude the first vacuum line12044 a. A filter 12027 a can be positioned in the first vacuum line12044 a. For example, the filter 12027 a can be positioned at leastpartially within the suction cassette assembly 12020, as illustrated inFIG. 12. In some embodiments, the filter 12027 a is an antimicrobialand/or hydrophobic filter. The filter 12027 a can be configured toreduce the likelihood that blood or other material from the storage tank12060 will pass into the first vacuum valve 12042 a and/or into thevacuum source 12040.

A second vacuum valve 12042 b can be positioned on the second vacuumline 12044 b. In some embodiments, the second vacuum valve 12042 b isconfigured to selectively occlude the second vacuum line 12044 b. Afilter 12027 b can be positioned in the second vacuum line 12044 b. Forexample, the filter 12027 b can be positioned at least partially withinthe suction cassette assembly 12020. In some embodiments, the filter12027 b is an antimicrobial and/or hydrophobic filter. The filter 12027a can be configured to reduce the likelihood that blood or othermaterials from the intermediate storage tank 12024 will pass into thesecond vacuum valve 12042 b and/or into the vacuum source 12040. In someembodiments, the intermediate storage tank 12024 includes a baffle (notshown) or other structure to reduce the likelihood of material ingressfrom the intermediate storage tank 12024 to the filter 12027 b and/or tothe second vacuum line 12044 b. For example, the baffle help to blockfluid from splashing directly from the second suction line 12080 b tothe second vacuum line 12044 b.

In some embodiments, the medical suction system 12000 includes a thirdvacuum valve 12042 c. The third vacuum valve 12042 c can be positionedon the second vacuum line 12044 b. In some embodiments, the third vacuumvalve 12042 c is fluidly connected to the second vacuum line 12044 bbetween the intermediate storage tank 12024 and the second vacuum valve12042 b. The third vacuum valve 12042 c can be used to moderate thepressure P2 within the intermediate storage tank 12024. For example, thethird vacuum valve 12042 c can be used to maintain the pressure P2within the intermediate storage tank 12024 within a predetermined range(e.g., 0-550 mm Hg, 200-800 mm Hg, etc.). In some embodiments, one ormore pneumatic indicators 12051 can be positioned on the vacuum lines12044 a, 12044 b. The indicators 12051 can be configured to providefeedback on pneumatic parameters (e.g., pressure).

In some embodiments, the vacuum source 12040 is configured to decreasethe pressure P1 within the storage tank 12060. For example, the firstvacuum valve 12042 a can be at least partially opened to allow for fluidcommunication between the vacuum source 12040 and the storage tank12060. In some embodiments, the vacuum source 12040 is configured tomaintain the pressure P1 within the storage tank 12060 below ambientpressure Pa. In some embodiments, the vacuum source 12040 maintains thepressure P1 within the storage tank 12060 at or near 600 mm Hg.

The medical suction system 12000 is configured to operate with a lowflow suction input and/or with a high flow suction input. For example,the first suction line 12080 a can be configured to operate as a highflow suction line. In some embodiments, the first suction line 12080 ais used to produce high flow at a sight of interest to suction, forexample, heavy bleeding. In some embodiments, the second suction line12080 b is configured to operate as a low flow suction line. Forexample, the second suction line 12080 b can be used to identify andcoagulate low flow bleeding on the surface of the brain without damagingthe brain.

In some embodiments, valves 12028 a, 12028 b (e.g., proportionalelastomeric valves) can be positioned on the suction lines 12080 a,12080 b, respectively. For example, valves 12028 a, 12028 b can be usedto open and/or close fluid communication between the first suction line12080 a and the storage tank 12060 and to open and/or close fluidcommunication between the second suction line 12008 b and theintermediate storage tank 12024, respectively.

Pneumatic Drive System

FIG. 13 illustrates a pneumatic drive system 12500. The pneumatic driveassembly can include a pneumatic pressure source 12540 (e.g., a hospitalcompressed gas system). In some embodiments, the pneumatic pressuresource 12540 is fluidly connected to one or more pneumatic actuators12552, 12554, 12562 (e.g., solenoids, pistons). One or more valves 12564(e.g., elastomeric proportional and/or venting valves) can be positionedon the fluid lines between the pneumatic pressure source 12540 and theone or more pneumatic actuators 12552, 12562.

In some embodiments, the pneumatic actuators 12562 are configured tooperate the valves of a hydraulic pressure circuit 3200(and/or thevalves of any of the embodiments of the hydraulic pressure circuitsdisclosed herein). In some embodiments, the actuator 12552 is configuredto operate a cassette lifter . The pneumatic actuators 12554 can beconfigured to operate as tube ejectors for peristaltic pumps used, forexample, in the hydraulic pressure circuits disclosed herein.

As illustrated in FIG. 13, the pneumatic drive system 12500 can includea safety valve 12542 and/or a pressure regulator 12544 (e.g., a 75 psipressure regulator) positioned on the fluid line between the pneumaticpressure source 12540 and the actuators 12562, 12552, 12554. One or morepneumatic indicators 12551 can be positioned on the fluid lines of thepneumatic drive system 12500. In some embodiments, one or morerestrictions 12557 can be applied to the fluid lines between the valves12564 and the actuators 12552, 12554, 12562.

Apparatus for Moving a Component

FIGS. 14A-19B illustrate embodiments of an apparatus 10100 that can beconfigured to allow a user to control the movement of one or morecomponents 18. With reference to FIG. 14A-15, a translation system 10200can have an upper connecting member 10210, a lower connecting member10220, and a guide assembly 10230 located therebetween. The upperconnecting member 10210 and the lower connecting member 10220 can beattached to the guide assembly 10230. The guide assembly 10230 can bedesigned to allow the lower connecting member 10220 to translate withrespect to the upper connecting member 10210. The lower connectingmember 10220 can be attached to control members 10110, 10115 andcomponent arm 10120.

As illustrated in FIG. 14A, the guide assembly 10230 can includemultiple guides in the form of tracks, rails, or similar structures. Inthe illustrated embodiment, the guides come in pairs. This canadvantageously increase the stability of the translation system 10200.In other embodiments, the guides can be single members or multiple (e.g,greater than two) members. In some embodiments, the guide assembly 10230can include an upper guide 10235, an x-axis intermediate guide 10240,and a y-axis intermediate guide 10245. Additionally, in someembodiments, the guide assembly 10230 can include a lower guide (notshown). The x-axis intermediate guide 10240 is oriented along the x-axisthereby allowing translation along the x-axis and the y-axisintermediate guide 10245 is oriented along the y-axis thereby allowingtranslation along the y-axis. The upper guide 10235 can be directlyattached to the upper connecting member 10210, such as a bottom surface,and oriented along the x-axis. In some embodiments, the lower guide canbe directly attached to the lower connecting member 10220, such as on atop surface, and oriented along the y-axis. The illustratedconfiguration can be used to allow the translation system 10200 totranslate along the x-y plane. As should be apparent to one of ordinaryskill in the art, the guide assembly 10230 can include additional guidesalong other axes or curvilinear guides. Furthermore, in someembodiments, multiple intermediate guides along the same axis can beused to advantageously increase the range of motion along that axis(e.g., via telescoping) without increasing the length of the guidesalong that axis. This can be especially beneficial in instances where acompact form factor is desired.

The guide assembly 10230 can include multiple guide connectors 10250,10255 which can be used to connect the multiple components of the guideassembly 10230 together. In the illustrated embodiment, the guideconnectors come in pairs although in other embodiments, single guideconnectors or multiple (e.g., greater than two) guide connectors can beused. These guide connectors 10250, 10255 can be designed to translatealong the path of the guides. As such, in embodiments using tracks orrails as guides, the connectors 10250, 10255 can be slidablytranslatable along the tracks or rails and can include mechanisms suchas rollers, ball bearings, or the like. During operation of theillustrated embodiment, the guide assembly 10230 can be translatedrelative to the upper connecting member 10210 via sliding across boththe upper guide 10235 and the x-axis intermediate guide 10240. The lowerconnecting member 10220 can thus translate relative to upper connectingmember 10210 along the x-axis. The lower connecting member 10220 can betranslated relative to the guide assembly 10230 by sliding across they-axis intermediate guide 10245.

With continued reference to FIGS. 14A, as illustrated in the embodimentcontained therein, the upper connecting member 10210 can be larger thanthe lower connecting member 10220. The range of translation along thex-axis can be greater than the range of translation along the y-axis. Inthe illustrated embodiment, the range of translation along the x-axis isapproximately ±175 mm and the range of translation along the y-axis isapproximately ±87.5 mm. Additionally, in some embodiments, the lowerconnecting member 10220 does not extend beyond the upper connectingmember 10210 along the y-axis. In other embodiments, the lowerconnecting member 10220 can extend beyond the upper connecting member10210 along the y-axis if desired for an extended range of motion.

The lower connection member 10220 can be translated relative to theupper connection member 10210 by translating the control members 10110,10115. As described above, in various embodiments, the joints 10111,10116 can be any joint that lacks translational degrees of freedom alongat least the x-axis and the y-axis. As such, a user of the translationsystem 10200 can move one control member such as control members 10110,10115 in the desired direction to translate the lower connection member10220 and ultimately the component 18 which can be attached thereto.Because movement of the component 18 is linked directly to the user'sphysical movement of the control member 10110, 10115, dexterous userscan find this type of mechanism more user-friendly and precise.Furthermore, in embodiments where the joints 10111, 10116 lacktranslation degrees of freedom along at least the x-axis and the y-axis,the other control member, such as control members 10110 or 10115, alsotranslate along with the lower connection member 10220. As such, a usercan control translation using any control member attached to the lowerconnection member 10220.

In some embodiments, the guide connectors 10550, 10555 can be designedto have a threshold friction such that the lower connection member 10220can only translate upon a threshold force being applied to the lowerconnection member 10220. Requiring a threshold force to be applied priorto movement can reduce the likelihood of unintentional movement of thetranslation system 10200 is reduced. In some embodiments, alternativecontrol mechanisms can be used in conjunction with, or in lieu of, thecontrol members 10110, 10115.

With reference to FIGS. 14A-B and 16A-D, as shown in the illustratedembodiment, the apparatus 10100 includes a pitch-yaw adjustment system10300. The pitch-yaw adjustment system 10300 can include member 10310which can connect two or more control members 10110, 10115. As describedin part above, the member 10310 can be connected to the two or morecontrol members 10110, 10115 and the component arm 10120 via joints10112, 10117, 10122 having two or more rotational degrees of freedom,such as a ball-and-socket joint. As should be apparent to one ofordinary skill in the art, other types of joints having a greater orfewer rotational degrees of freedom can be used.

The member 10310 can be configured to link the motion of multiplecontrol members 10110, 10115 and the component arm 10120. For example,in the illustrated embodiment, when adjusting the yaw of one controlmember 10110, the yaw of the other control member 10115 and componentarm 10120 correspondingly adjusts via mechanical movement. In much thesame way, in the illustrated embodiment, when adjusting the pitch of onecontrol member 10110, the pitch of the other control member 10115 andcomponent arm 10120 also correspondingly adjusts. This provides theadvantage of allowing a user of the pitch-yaw adjustment system 10300 toadjust pitch or yaw of the component arm 10120, and ultimately thecomponent 18, using only one of potentially multiple control memberssuch as control members 10110 or 10115 in the illustrated embodiment. Auser may advantageously choose whichever control member 10110, 10115 ismost convenient to use at the time an adjustment is necessary.Additionally, this may facilitate use by multiple users. For example,during a medical procedure, a medical professional on one side may useone control member 10110. If a second medical professional or assistantneeds to make an adjustment, the second medical professional orassistant may use the other control member 10115 if more readilyaccessible.

In some embodiments, the member 10310 can be attached to the controlmembers 10110, 10115 and the component arm 10120 such that adjustment ofyaw and/or pitch of the control members 10110, 10115 can result in morethan or less than a one-to-one adjustment in the yaw or pitch of thecomponent arm 10120. For example, as illustrated in FIG. 16A, thedistance between the joints 10111, 10112 of the first control member10110 and the distance between the joints 10116, 10117 of the secondcontrol member 10115 is greater than the distance between the joints10121, 10122 of the component arm 10120. This can result in greater thana one-to-one adjustment in the yaw of the component arm 10120. Themember 10310 shown in FIGS. 16B and 16C can result in a one-to-one andless than one-to-one adjustment in the yaw of the component arm 10120respectively. For example, as illustrated in FIG. 16C, the distancebetween the joints 10111, 10112 of the first control member 10110 andthe distance between the joints 10116, 10117 of the second controlmember 10115 is less than the distance between the joints 10121, 10122of the component arm 10120. In some embodiments, the pitch-yawadjustment system 10300 can be adjustable such that the user may choosewhether to use a one-to-one adjustment ratio, greater than a one-to-oneratio, or less than a one-to-one ratio. For example, as illustrated inFIG. 16D, the member 10310 can include a plate 10306 having a slot 10307in which the joint 10122 of the component arm 10120 can be adjustedvertically to adjust the joint connection points thereby adjusting theratio. Other types of adjustment mechanisms can be used such as multipleapertures vertically arranged as well as other mechanisms known in theart.

In some embodiments, a link member 10305 can also be used. The linkmember 10305 can be designed to attach to the control members 10110 and10115 to provide greater structural rigidity. For example, link member10305 can be connected to control members 10110 and 10115 using jointshaving fewer degrees of freedom. For example, the link member 10305 canbe attached to control member 10110 at joint 10113 and attached tocontrol member 10115 at joint 10118. In some embodiments, the joint canhave a single degree of rotational freedom such as a pin-and-aperturedesign. By limiting the degrees of freedom, the control members 10110and 10115 can be more likely to remain co-planar when rotating in pitchand/or yaw thereby reducing the potential for twisting. In someembodiments, the link member 10305 can be used in lieu of member 10310.

In some embodiments, such as that illustrated in FIG. 15, transmittingdrive members 10405, 10410 and receiving drive member 10415 (shown inFIG. 19A) can be arranged as shown in FIGS. 16A-16D to link the controlmember 10110, 10115 to the component arm 10120 and vary the adjustmentratio. Additionally, in some embodiments, other means of adjusting thepitch and/or yaw may be included.

With reference to FIG. 15, an embodiment of the apparatus 10100 is shownwhich includes a translation control system 10200, pitch/yaw adjustmentsystem 10300, and a z-distance adjustment system 10400. This embodimentshares some general characteristics with the embodiment of FIG. 14A-Bwith modifications made to accommodate the z-distance adjustment system10400. For example, joints 10112, 10117, and 10122 can be capstans whichallow these joints to be operably coupled to the z-distance adjustmentsystem 10400. In some embodiments, the z-distance adjustment system10400 can include a drive assembly 10401.

As illustrated in FIGS. 15 and 19A-B, the drive assembly 10401 caninclude multiple transmitting drive members 10405, 10410 attached to thecontrol members 10110, 10115 respectively being disposed in andconnected to apertures 10406, 10411 via joints 10112, 10117respectively, receiving drive member 10415 attached to the component arm10120 in aperture 10416 via joint 10122, and transmission member, suchas cable 10420, designed to transmit torque from the transmitting drivemembers 10405, 10410 to the receiving drive members 10415. The cable10420 can be tensioned on receiving drive member 10415 using cabletensioners 10430, 10435. The drive members 10405, 10410, 10415 can becentered along apertures 10315, 10320, 10325 respectively of the member,such as support member 10310. The cable tensioners 10430 and 10435 canbe centered along apertures 10330 and 10335 of member 10310respectively. In some embodiments, such as shown in FIG. 19B, a toothedbelt can be used with corresponding gears. Additionally, in someembodiments, such as illustrated in FIG. 19B, two transmissions members10420 and 10425 can be used to connect the drive members. As should beapparent to one of ordinary skill in the art, separate cables, with orwithout tensioners, or any other transmission members can be used.Additionally, other drive member designs, such as crown gears which canbe used with transmission shafts having beveled gears, can also be used.

As shown in FIGS. 17 and 18, in one embodiment, the component arm 10120can comprise a four-bar linkage assembly for adjusting the z-distance.In this embodiment, the component arm 10120 can include a shaft 10450attached to the joint 10121 and a sleeve 10455 over the shaft 10450which is rotatable around the longitudinal axis of the shaft 10450. Thesleeve 10455 can include a torque receiving joint 10460, such as theillustrated capstan, at one end which can be received within aperture10416 (see FIG. 19A-B) of the receiving drive member 10415, such as theillustrated keyed aperture, to receive a torque to rotate the sleeve10455. The sleeve 10455 can include a first rotation redirecting member10465, such as the illustrated bevel gear, at a second end which caninteract with a second rotation redirecting member 10466, such as theillustrated corresponding bevel gear, on an end of a driven link 10470of the four-bar linkage assembly. As such, rotation of the sleeve 10455can result in rotation of the driven link 10470 around a different axis.Rotation of the driven link 10470 can result in vertical movement of thearm.

In some embodiments, the four-bar linkage assembly may include, inaddition to a driven link 10470, a shaft link 10471 which can be rigidlyattached to the shaft 10450, a free link 10472, and a hinge unit 10475.In some embodiments, a second four-bar linkage assembly can be includedwith a second free link 10480 and third free link 10481, a hinge unit10475 attached to the first four-bar linkage assembly, and a secondhinge unit 10485 for attaching the component 18 to the component arm10120. In such embodiments, mechanisms may be added between the firstfour-bar linkage assembly and the second four-bar linkage assembly suchthat the second four-bar linkage assembly will correspondingly rotatewhen the driven link 10470 is rotated. For example, the first free link10472 and the second free link 10480 can be rotatably connected viagearing. The gearing can be chosen such that there is a one-to-onerotational transfer between the first free link 10472 and the secondfree link 10480. In other embodiments, the gearing can be chosen suchthat there is greater than a one-to-one rotational transfer or lesserthan a one-to-one rotational transfer. As should be appreciated by oneof ordinary skill in the art, the lengths of the links and the ratio ofthe gearing can be chosen such that the z-distance adjustment system10400 can adjust the z-distance, that is, adjust the position of thecomponent 18 in a direction generally parallel to the z-axis, withoutcausing any or at least a small amount of translation of the componentin either the x-axis or y-axis.

The four-bar linkage component arm 10120 provides the advantage ofreducing the form factor when the z-distance is greater. Due to thecompact form factor of the four-bar linkage component arm 10120, thecomponent 18 can be placed closer to the lower connecting member 10220.

In other embodiments, the component arm 10500 can include a screw-driveassembly for adjusting the z-distance. In this embodiment, the componentarm 10500 can include two struts members 10505, 10510 designed tosupport the component arm 10500 rigidly attached to a first end 10515and second end 10520, a screw member 10525 rigidly attached to the firstend 10515, the second end 10520 and the component 18, and a threadedtorque receiving joint 10530, such as the illustrated capstan, at oneend which can be received within aperture 10416 (see FIG. 19A-B) of thereceiving drive member 10415, such as the illustrated keyed aperture, toreceive a torque to rotate the torque receiving joint 10530 (in someembodiments, torque receiving joint 10530 can also be the joint 10122such as shown in FIG. 15). In some embodiments, the torque receivingjoint 10530 can be supported by the receiving drive member 10415.Furthermore, in some embodiments, the two strut members 10505, 10510 andthe screw member 10525 may freely translate through the joint 10501. Inthis embodiment, because torque receiving joint 10530 is threaded andscrew member 10525 is rotationally fixed along the z-axis due to joint10501 having only two degrees of rotational freedom, rotation of thetorque receiving joint 10530 can result in translation of the component18 in a direction along the length of screw member 10525 (e.g., thez-axis) via the screw member 10525. As should be appreciated by one ofskill in the art, the pitch of the threaded torque receiving joint 10530and the screw member 10525 can be chosen to determine the amount oftranslation per revolution of the joint 10530. Increasing the pitch canresult in greater z-distance adjustment per revolution whereas decreasedpitch can result in lesser z-distance adjustment per revolution.

The z-distance adjustment system 10400 can be operated by using thecontrol members 10110, 10115. In the illustrated embodiment, controlmember 10110 can be rotatably coupled to transmitting drive member 10405via aperture 10406, such as the illustrated keyed aperture, and controlmember 10115 can be rotatably coupled to transmitting drive member 10410via aperture 10411. In some embodiments, the rotatable coupling can beachieved through use of a capstan, such as 10112 and 10117 of FIG. 15,which can be similar to the torque receiving joint 10460, 10530 of thecomponent arm 10120, 10500 shown in FIGS. 17 and 18. As such, rotationof either control member around the z-axis results in rotation of therespective transmitting member. In some embodiments, since thetransmitting drive members 10405, 10410 and receiving drive member 10415can be physically coupled via transmission members 10420 such as acable, toothed belt or similar apparatus, rotation of one control membercan result in rotation of any other attached control member andcomponent arm. As such, this provides the advantage of allowing thez-distance adjustment system 10400 to be operated using only a singlecontrol member.

As should be apparent to one of ordinary skill in the art, the radius ofthe transmitting drive members 10405, 10410 and receiving drive member10415 can be chosen to modify the speed of the z-distance adjustment.For example, in some embodiments, the transmitting drive members 10405,10410 can have a larger radius than the receiving drive member 10415such that, for a single revolution of a control member 10110, 10115, thereceiving drive member 10415 rotates more than one revolution.

Various embodiments may comprise a retractor, use a retractor, or areconfigured to be used with a retractor and not an endoscope,laparoscope, or arthroscope. Similarly, many embodiments compriseretractors or use retractors or are configured to be used withretractors wherein cameras are disposed on the retractors, notendoscope, laparoscope, or arthroscope.

In various embodiments the retractor fits in an opening in a manner toprovide ample room for the surgeon to operate but does not provide a gasseal for pumping up a cavity as may a laparoscope. Similarly, in manyembodiments the retractor does not maintain alignment of the layers oftissue that are cut through to form the incision.

In various embodiments, the retractor is not employed as a fulcrum forsurgical tools.

In various embodiments the camera(s) can be positioned on top of theretractor near and above the body surface or on the retractor at a depthwithin the surgical site (e.g., at the far distal end of the retractorinto the deepest portion of the surgical site, or elsewhere on theretractor such as more proximal).

Many embodiments are employed for spine surgery, neurosurgery, headand/or neck surgery, and ear nose and throat surgery and manyembodiments involve the cutting and extraction of bone, for example,through the pathway provided by the retractor.

Various embodiments, however, may be used with devices other thanretractors.

Many other embodiments are possible, including numerous combinations ofthe above recited features.

The embodiments described herein can differ from those specificallyshown. For example, various elements of the different embodiments may becombined and/or rearranged. Components can be added, removed and/orrearranged. A wide variety of variations are possible.

Conclusion

Unless otherwise indicated, the functions described herein may beperformed by software (e.g., including modules) including executablecode and instructions running on one or more systems including one ormore computers. The software may be stored in computer readable media(e.g., some or all of the following: optical media (e.g., CD-ROM, DVD,Blu-ray, etc.), magnetic media (e.g., fixed or removable magneticmedia), semiconductor memory (e.g., RAM, ROM, Flash memory, EPROM,etc.), and/or other types of computer readable media.

The one or more computers can include one or more central processingunits (CPUs) that execute program code and process data, non-transitory,tangible memory, including. for example, one or more of volatile memory,such as random access memory (RAM) for temporarily storing data and datastructures during program execution, non-volatile memory, such as a harddisc drive, optical drive, or FLASH drive, for storing programs anddata, including databases, a wired and/or wireless network interface foraccessing an intranet and/or Internet, and/or other interfaces.

In addition, the computers can include a display for displaying userinterfaces, data, and the like, and one or more user input devices, suchas a keyboard, mouse, pointing device, touch screen, microphone and/orthe like, used to navigate, provide commands, enter information, providesearch queries, and/or the like. The systems described herein can alsobe implemented using general-purpose computers, special purposecomputers, terminals, state machines, and/or hardwired electroniccircuits.

Various embodiments provide for communications between one or moresystems and one or more users. These user communications may be providedto a user terminal (e.g., an interactive television, a phone, alaptop/desktop computer, a device providing Internet access, or othernetworked device). For example, communications may be provided viaWebpages, downloaded documents, email, SMS (short messaging service)message, MMS (multimedia messaging service) message, terminalvibrations, other forms of electronic communication, text-to-speechmessage, or otherwise.

Various modifications to the implementations described in thisdisclosure may be readily apparent to those skilled in the art, and thegeneric principles defined herein may be applied to otherimplementations without departing from the spirit or scope of thisdisclosure. Thus, the claims are not intended to be limited to theimplementations shown herein, but are to be accorded the widest scopeconsistent with this disclosure, the principles and the novel featuresdisclosed herein.

Certain features that are described in this specification in the contextof separate embodiments also can be implemented in combination in asingle embodiment. Conversely, various features that are described inthe context of a single embodiment also can be implemented in multipleembodiments separately or in any suitable subcombination. Moreover,although features may be described above as acting in certaincombinations and even initially claimed as such, one or more featuresfrom a claimed combination can in some cases be excised from thecombination, and the claimed combination may be directed to asubcombination or variation of a subcombination.

Similarly, while operations may be described as occurring in aparticular order, this should not be understood as requiring that suchoperations be performed in the particular order described or insequential order, or that all described operations be performed, toachieve desirable results. Further, other operations that are notdisclosed can be incorporated in the processes that are describedherein. For example, one or more additional operations can be performedbefore, after, simultaneously, or between any of the disclosedoperations. In certain circumstances, multitasking and parallelprocessing may be advantageous. Moreover, the separation of varioussystem components in the embodiments described above should not beunderstood as requiring such separation in all embodiments, and itshould be understood that the described program components and systemscan generally be integrated together in a single product or packagedinto multiple products. Additionally, other embodiments are within thescope of the following claims. In some cases, the actions recited in theclaims can be performed in a different order and still achieve desirableresults.

1.-43. (canceled)
 44. A medical apparatus comprising: a camera; aflexible cable, the camera attached to the flexible cable; a rigidplatform, the camera supported on the rigid platform; and a housing, thehousing and rigid platform forming a unit, wherein the camera iscontained in the housing such that the flexible cable extends from theunit formed by the housing and the rigid platform with the cameratherein, wherein the camera and the unit are configured to be lowered orraised within a surgical site formed by an incision in the body bylowering or raising the flexible cable with respect to the surgicalsite.
 45. The medical apparatus of claim 44, wherein the camera isdisposed at a distal end of the unit.
 46. The medical apparatus of claim44, wherein the camera is configured to be tilted.
 47. The medicalapparatus of claim 46, wherein the camera is configured to be tiltedinward and downward into the surgical site.
 48. The medical apparatus ofclaim 44, wherein the camera comprises a sensor and optics arranged withrespect to the sensor.
 49. The medical apparatus of claim 48, whereinthe housing comprises a window through which an image can be taken viathe optics and sensor.
 50. The medical apparatus of claim 44, whereinthe housing extends upward at a distal end of the housing.
 51. Themedical apparatus of claim 44, wherein the housing is thicker at adistal end.
 52. The medical apparatus of claim 44, wherein the housingcomprises smooth curves.
 53. The medical apparatus of claim 44, furthercomprising a port configured to provide fluid to clean the camera. 54.The medical apparatus of claim 53, wherein the port is configured toprovide liquid and air to clean the camera.